The anterior cutaneus nerve entrapment syndrome (ACNES). Randomized double blind controlled trial for the diagnosis and treatment of entrapment of the anterior cutaneus nerve through the rectus muscle.

Entrapment of one or more nerve branches in the rectus abdominis muscle , known
as the anterior cutaneus nerve entrapment syndrome (ACNES), can cause abdominal
pain and discomfort. It is often overseen as a cause of abdominal pain. Once
diagnosed several therapeutic options are available. Our studiegroup propagates
neurectomy, dissection of the nerve branches perforating the anterior fascia of
the rectus abdominis muscle. In our own experience this leads to succesfully
improving complaints in patients in about 75 % of the cases. Pain specialists
and non-believers remain critical and doubt the surgical intervention to be
usefull for various reasons.

Evaluation of the effect ofdiagnostic and therapeutic proces in reducing pain
in patients suspected with ACNES.

Is injection of lidocaine in patients suspected of ACNES leading to a larger
group of people with a clinically relevant reduction of pain compaired to
saline? Is neurectomy in patients suspected of ACNES leading to a larger group
of people with a clinically relevant reduction of pain compaired to a 'sham'
operation.

a 50 % reduction on the Visual Analouge Scale (VAS) is considered clinically
relevant.

Double-blind randomised mono-centre trial devided in an diagnostic fase and a
therapeutic fase.

Fase 1, diagnostic: Injection of lidocaine vs saline at the painpoint
Fase 2, therapeutic conservative: injection of lidocaine and Kenacort at the
painpoint in all patients
Fase 3, therapeutic operative: Neurectomy vs Sham operation.

The risk is cinsidered minor and no different than any procedure. Both
infection and hematoma are the most common complications, alltough rare (less
than 5 %), for injection and/or surgery. Sujested surgery is superficial and
minor.

The biggest burden is on those subjected to a sham or placebo procedure. They
potentially remain in pain for at least 6 weeks more. Eventually they will be
offered a neurectomy at a later state. No longterm os irriversable hazzards are
to be expected.

There is no personal benefit. This study will provide evidency of the entity
ACNES and usefull treatment. More widespread knowlege of ACNES might prevent
future patients to be submitted to unnecessary diagnostic procedures and even
major abdominal surgery