Ultrasound-Guided Nerve Hydrodissection for Pain Management: An Updated Review of Anatomy and Techniques

Abstract

Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves using an anesthetic or solution such as saline or 5% dextrose solution to separate the nerve from the surrounding tissue, fascia, or adjacent structures. This technique aims to treat neuropathic pain, or pain caused by the nerve. Ultrasound-guided HD of peripheral nerves has gained significant attention in the medical profession and pain management fields in recent years. This is due to a number of high impact publications of randomized control trials demonstrating the efficacy and safety of this technique for the treatment of carpal tunnel syndrome. Even the 20th edition of Harrison’s Principles of Internal Medicine textbook lists injection of 5% dextrose as an alternative local treatment that does not have the side effects of corticosteroids. At present, there is no review of the current literature on this technique. This manuscript will summarize and discuss the following: 1) the different approaches to doing ultrasound-guided HD of nervous structures, 2) its usages in different clinical situations, 3) its clinical pearls, 4) the solution used, and 5) the postulated mechanisms of action.

Ultrasound-guided hydrodissection of sural nerve for foot pain- A case report

“…In nerve hydrodissection ultrasound-guided fluid is injected to separate nerve from the surrounding structure, usually the fascia, which is believed to constrict or irritate the nerve either during movement or at rest. (15,16) The advantage of nerve hydrodissection is separation of nerves from the surrounding soft tissue with fluid (hydro) and with the fluid flushing and the release of pressure on the nervi nervorum outside the epineurium. (16) These nervi nervorum are the free nerves supplying the main nerve and regulate the function and discharge of the main nerve.…”

“…(15,16) The advantage of nerve hydrodissection is separation of nerves from the surrounding soft tissue with fluid (hydro) and with the fluid flushing and the release of pressure on the nervi nervorum outside the epineurium. (16) These nervi nervorum are the free nerves supplying the main nerve and regulate the function and discharge of the main nerve. (14) Real time ultrasonography is usually the choice of imaging technique in nerve hydrodissection to guide needles and fluid injection.…”

“…Along with that a small volume of steroid and local anesthetic solution is also injected to reduce the pain. (16) We performed hydrodissection using 0.9% normal saline 10 mL, methylprednisolone 40 mg and 1% lidocaine at the entrapment site, which was behind the lateral malleolus due to fasicular hypertrophy of the peroneal retinaculam. The outcome was excellent during follow-up up to 3 months.…”

Hydro-dissection of Dorsal Scapular Nerve for Neuropathy Post Radical Neck Dissection and Radiation: A Case Report

“…"Hydro-dissection" is a technique wherein the fluid (local anesthetic or saline or 5% dextrose in water) is injected under pressure so as to separate the nerve from the adjacent structures. [4] It is a minimally invasive procedure predominantly applied for carpal tunnel syndrome in the beginning, while it is used for other various neuropathies as well subsequently. [4] We report here a case of neuropathy of DSN following radiotherapy in a young patient with salivary ductal carcinoma for whom we could at least provide pain relief by performing hydro-dissection of DSN as a palliative measure.…”

“…[4] It is a minimally invasive procedure predominantly applied for carpal tunnel syndrome in the beginning, while it is used for other various neuropathies as well subsequently. [4] We report here a case of neuropathy of DSN following radiotherapy in a young patient with salivary ductal carcinoma for whom we could at least provide pain relief by performing hydro-dissection of DSN as a palliative measure. To the best of our knowledge, hydro-…”