Articles et videos reliés à l'hydrodissection
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Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms
J Pain Res. 2020 Aug 4;13:1957–1968. doi: 10.2147/JPR.S247208
King Hei Stanley Lam
Abstract:
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.
A Novel Ultrasound-Guided Bilateral Vagal NerveHydrodissection With 5% Dextrose Without LocalAnesthetic for Recalcitrant Chronic MultisitePain and Autonomic Dysfunction
Chronic pain is a complex condition that often poses diagnostic and management challenges due to itsmultifactorial etiology. This case report describes a 49-year-old pastor who presented with a three-yearhistory of chronic pain affecting multiple sites, including the neck, bilateral shoulders, thoracic region, lowerback, and bilateral knees. Additionally, he experienced shortness of breath on mild exertion, whichadversely affected his ability to converse and speak publicly. The patient had a rapid resting heart rate of100-120 beats per minute, occasional palpitations, and a 24-hour electrocardiogram that confirmed 15%premature ventricular complexes with bigeminy and trigeminy. He complained of limited appetite with earlysatiety, intermittent nausea, and regurgitation. Despite consultations with multiple specialists, nounderlying causes were identified in the cardiac, respiratory, gastrointestinal, or psychological domains.Ultrasound-guided bilateral vagus nerve hydrodissection using 5% dextrose without local anesthetics wasadministered three times at monthly intervals, resulting in remarkable pain relief within three months andthe effects persisted at the nine-month follow-up. Tachycardia was no longer perceived, resting heart rateslowed to 70-80 beats per minute, shortness of breath improved, and public speaking ability wasrestored. The patient's early satiety, nausea, and reflux complaints were resolved. This case report highlightsthe potential effectiveness of this novel intervention for chronic pain. Further research is warranted tovalidate these findings and explore the mechanism of action.
Ultrasound-Guided Hydrodissection of theThoracodorsal Nerve and Axillary Nerve in aGymnast With Shoulder Pain Associated WithSuperior Labral Anterior-Posterior Lesions: ACase Report
Transition from Deep Regional Blocks toward Deep Nerve
Hydrodissection in the Upper Body and Torso: Method
Description and Results from a Retrospective Chart Review of
the Analgesic Effect of 5% Dextrose Water as the Primary
Hydrodissection Injectate to Enhance Safety
Abstract:
A 20-year-old male national-level gymnast presented with left shoulder pain attributed to a superior labralanterior-posterior (SLAP) lesion. Physical examination revealed pain in the anterosuperior area at maximumshoulder elevation, with a positive combined abduction test and horizontal flexion test indicating arestriction in glenohumeral joint motion. Rather than directly addressing the SLAP lesion, ultrasoundguidedhydrodissections of the thoracodorsal and axillary nerves were performed, leading to immediatealleviation of pain and mobility constraints. This innovative approach, emphasizing shoulder function,offers a novel therapeutic strategy for SLAP-associated shoulder pain in athletes.
Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain.The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of 16±12.2 months and the mean Numeric Pain Rating Scale (NPRS) 0–10 pain level of 8.3±1.3.Themean percentage of analgesia
during each treatment session involving D5W injection without anesthetic was 88.1% ± 9.8%. The pretreatment Numeric Pain Rating Scale score of 8.3 ± 1.3 improved to 1.9 ± 0.9 at 2 months after the last treatment. Patients received 3.8 ± 2.6 treatments over 9.7 ± 7.8 months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides
cumulative pain reduction.
Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative
Review
Cervical myofascial pain is a very common clinical condition in the daily practice ofmusculoskeletal physicians. Physical examination is currently the cornerstone for evaluating thecervical muscles and identifying the eventual presence of myofascial trigger points. Herein, the roleof ultrasound assessment in precisely localizing them is progressively mounting in the pertinentliterature. Moreover, using ultrasound, not only the muscle tissue but also the fascial and neuralelements can be accurately located/evaluated. Indeed, several potential pain generators, in additionto paraspinal muscles, can be involved in the clinical scenario of cervical myofascial pain syndrome.In this article, the authors extensively reviewed the sonographic approach for cervical myofascialpain in order to better diagnose or guide different procedures that can be performed in the clinicalpractice of musculoskeletal physicians.