Continuous thoracic epidural analgesia as a bridge to delivery for refractory pregnancy-associated anterior cutaneous nerve entrapment syndrome
Yoshihiro Ishii, Yoshihiko Hosokawa, Shinichiro MoriAnterior cutaneous nerve entrapment syndrome (ACNES) is an underrecognized cause of abdominal wall pain. Pregnancy-associated ACNES is uncommon, and its optimal management remains uncertain. A 38-year-old woman in her first pregnancy at 37 weeks and 2 days of gestation presented with severe localized abdominal pain and a positive Carnett's sign. Repeated local anesthetic injections provided insufficient relief. Continuous thoracic epidural analgesia at the T8–T9 level achieved sustained pain control and served as a bridge to cesarean delivery. No recurrence was observed during the first postpartum week. This case suggests that continuous thoracic epidural analgesia may be considered for refractory pregnancy-associated ACNES when less invasive treatments are ineffective.