Subcostal Transversus Abdominis Plane (STAP) Block with Depot Steroids in the Management of Upper Abdominal Myofascial Pain Syndrome (AMPS)q

G Niraj

doi:10.15436/2377-1364.17.093

Abstract

Background: Abdominal myofascial pain syndrome is a poorly recognised cause of chronic abdominal wall pain. Diagnosis is confirmed by a positive response to trigger point injection. In the presence of extensive myofascial pain, trigger point treatment can result in patient discomfort and distress. Recently, posterior transversus abdominis plane blocks have been reported in the diagnosis and treatment of chronic abdominal wall pain. Subcostal transversus abdominis plane block is an abdominal wall block that is effective for pain arising from the upper abdomen. The report describes the role of the ultrasound guided subcostal transversus abdominis plane block in the management of abdominal myofascial pain syndrome.Methods: Adult patients with myofascial pain syndrome localised in the upper abdomen under the care of a single physician at a tertiary pain medicine unit were offered bilateral ultrasound guided subcostal transversus abdominis plane block with a mixture of local anaesthetic and depot methylprednisolone instead of multiple trigger point injections as a part of an on-going prospective longitudinal audit into the management of abdominal myofascial pain syndrome. Patients completed brief pain inventory questionnaire at baseline and at 12 weeks post procedure.Results: Twenty patients underwent bilateral subcostal transversus abdominis plane blocks with depot steroids. All patients reported complete absence of pain within 15 minutes of the block. Clinically significant benefit at 12 weeks was reported by 60 % (12/20) of patients.Conclusion: Subcostal transversus abdominis plane block with depot steroids could play a role in the management of myofascial pain of the upper abdomen.

Highlights

Abdominal myofascial pain syndrome (AMPS) is a common but often poorly recognised cause of chronic abdominal wall pain (CWAP)[1-3]
The author presents the first report on the use of ultrasound guided subcostal transversus abdominis plane block with depot steroid in the management of AMPS arising from the upper abdomen
Ultrasound scanning revealed severe postsurgical scarring of the Subcostal Transversus Abdominis Plane (STAP) fascial plane and the procedure was abandoned. This patient underwent trigger point injections (7 triggers) that resulted in significant post-procedural flare up

Summary

Introduction

Abdominal myofascial pain syndrome (AMPS) is a common but often poorly recognised cause of chronic abdominal wall pain (CWAP)[1-3]. Severe vomiting and retching induced by gastritis secondary to alcohol excess can result in the development of trigger points in the upper rectus muscle. In this scenario, both traumatic injury to the upper rectus muscle and underlying visceral inflammation play a role in muscle dysfunction. Patients often have multiple tender points in the upper rectus muscle as well as in the muscles that constitute the anterolateral abdominal wall (external and internal oblique and transversus abdominis). The author presents the first report on the use of ultrasound guided subcostal transversus abdominis plane block with depot steroid in the management of AMPS arising from the upper abdomen.

Results

Methods

Procedure abandoned

Discussion