Hydrodissection for Chronic Pain

Often times nagging injuries and chronic pain are caused by nerves not working right.  Imagine the power cord to your computer getting bent and squeezed to the point that the wires inside it start to fray. Eventually, the power cord doesn’t work and we can’t charge our battery.  The same thing happens with the nerves in our bodies.  Sometimes they get squeezed (compressed or entrapped) due to their anatomical course.  

We can inject fluid around the nerve, called hydrodissection, to free up the area of compression and restore normal function to the nerve.  Nerve compression can also happen after injuries, infections, surgeries or anything else that causes scar tissue to develop.  We use ultrasound guidance to identify the nerves and precisely guide the needle and watch the fluid flow around the nerve.  Often times, people feel immediate relief. Nerve compression is common around the fibular head.  I have seen several patients come in with foot drop which didn’t resolve after lumbar spine surgery.  After releasing the fibular nerve, their foot drop improves significantly. 

Why does this work?  Minimal compression on nerves is capable of creating structural changes in the nerves as well as neuropathic pain.  By injecting D5W (a sterile 5% dextrose solution in water) around the nerve, the pressure is released and the nerve function is restored.  D5W is essentially dilute sugar water.  There is also evidence that compressed nerves are not getting the adequate glucose necessary for metabolic processes. By injecting with D5W, it feeds the nerves as well as releasing them. Studies have been done to compare surgical release of the carpal tunnel vs steroid injections vs hydrodissection with D5W and hydrodissection comes out on top.  

 

Nerve blocks are common treatments for chronic pain. They involve injecting local anesthetic around the nerve and blocking it.  The idea is it gives the nerve a rest and a chance to re-boot.  There is more recent evidence that they may be effective because the fluid injected around the nerve releases the pressure and restores nerve function.  D5W has mild anesthetic properties and is safer than using local anesthetics.  Local anesthetics can cause toxicity and even death in high doses or if accidentally injected into blood vessels. 

See more about the different nerve treatments that Boost offers.

Here are some articles about hydrodissection:

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

Ultasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms

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Allison

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