Siawash Murid, Mol Frederique, Tjon-A-Ten Walther, Perquin Christel, van Eerten Percy, van Heurn Ernst, Roumen Rudi, Scheltinga Marc
Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands.
Paediatr Anaesth. 2017 May;27(5):545-550. doi: 10.1111/pan.13084. Epub 2017 Mar 10.
Chronic abdominal pain in children may be caused by the anterior cutaneous nerve entrapment syndrome. Local nerve blocks are recommended as an initial treatment in adults. Evidence on effectiveness and safety of such a treatment in children is lacking.
Our aim was to study outcome and adverse events of anterior rectus sheath blocks in childhood anterior cutaneous nerve entrapment syndrome.
Patients <18 years of age receiving anterior rectus sheath blocks were prospectively followed. Injections were administered using a free-hand technique in the outpatient department.
A total of 85 children were included (median age 15 years, range 8-17, 76% female). Eighty-three children reported immediate pain relief following a single lidocaine block and 13 achieved long-term success. Another 19 children was successfully treated with additional blocks combined with steroids. A total 38% success ratio was attained after a median 17-month follow-up (range, 4-39). Pain intensity and diagnostic delay were not associated with a beneficial outcome. However, young age predicted success. An infrequently occurring adverse event was temporarily increased pain some 6 h post injection.
Anterior rectus sheath blocks using local anesthetics and steroids are safe and long-term successful in more than one-third of children suffering from abdominal pain due to anterior cutaneous nerve entrapment syndrome.
儿童慢性腹痛可能由前皮神经卡压综合征引起。在成人中，局部神经阻滞被推荐作为初始治疗方法。但缺乏关于这种治疗方法在儿童中的有效性和安全性的证据。
我们的目的是研究儿童前皮神经卡压综合征中腹直肌鞘阻滞的治疗效果和不良事件。
对年龄小于18岁接受腹直肌鞘阻滞的患者进行前瞻性随访。在门诊采用徒手技术进行注射。
共纳入85名儿童（中位年龄15岁，范围8 - 17岁，76%为女性）。83名儿童在单次利多卡因阻滞注射后立即报告疼痛缓解，13名获得长期成功。另外19名儿童通过额外的阻滞联合类固醇治疗成功。中位随访17个月（范围4 - 39个月）后，总成功率达到38%。疼痛强度和诊断延迟与良好的治疗效果无关。然而，年龄小预示着治疗成功。一种不常发生的不良事件是注射后约6小时疼痛暂时加重。
对于因前皮神经卡压综合征引起腹痛的儿童，使用局部麻醉剂和类固醇进行腹直肌鞘阻滞在超过三分之一的儿童中是安全且长期有效的。
