Journal of Pain Research (Aug 2020)
Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms
Abstract
King Hei Stanley Lam,1,2 Chen-Yu Hung,3 Yi-Pin Chiang,4,5 Kentaro Onishi,6 Daniel Chiung Jui Su,7 Thomas B Clark,8 K Dean Reeves9 1The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong; 2Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong; 3Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; 4Department of Physical Medicine and Rehabilitation, MacKay Memorial Hospital, Taipei, Taiwan; 5Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; 6Department of PM&R and Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 7Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan; 8Private Practice Ultrasonographic Training, Vista, CA, USA; 9Private Practice PM&R and Pain Management, Roeland Park, KS, USACorrespondence: King Hei Stanley Lam Tel +852 98761688Fax +852 23720848Email [email protected]: Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves the injection of an anesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue, fascia, or adjacent structures. Animal models suggest the potential for minimal compression to initiate and perpetuate neuropathic pain. Mechanical benefits of HD may relate to release of nervi nervorum or vasa nervorum compression. Pathologic nerves can be identified by examination or ultrasound visualization. The in-plane technique is the predominant and safest method for nerve HD. Five percent dextrose may be favored as the preferred injectate based on preliminary comparative-injectate literature, but additional research is critical. Literature-based hypotheses for a direct ameliorative effect of dextrose HD on neuropathic pain are presented.Keywords: nerve hydrodissection, pain management, ultrasonography, neuropathic pain
