Journal of Anesthesia and Surgery
Subcostal Transversus Abdominis Plane (STAP) Block with depot steroids in the management of upper abdominal myofascial pain syndrome (AMPS)
Consultant, Department of Pain Medicine, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust.
Dr. Niraj, G. Consultant, Department of Anaesthesia and Pain Medicine, Honorary Senior Lecturer, University of Leicester, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, E-mail: firstname.lastname@example.org
Niraj, G. Subcostal Transversus Abdominis Plane (STAP) Block with Depot Steroids in the Management of Upper Abdominal Myofascial Pain Syndrome (AMPS). (2017) J Anesth Surg 4(2): 111- 114.
© 2017 Niraj, G. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.
KeywordsSubcostal transversus abdominis plane; Abdominal myofascial pain syndrome; Depot steroids
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.