NERVE HYDRODISSECTION: A THERAPEUTIC INJECTION FOR COMPLEX REGIONAL PAIN SYNDROME
INTRODUCTION AND OBJECTIVE
Complex regional pain syndrome (CRPS) is diagnosed based on International Association for the Study of Pain (IASP) diagnostic criteria. In Type I CRPS there is no evidence of nerve injury while in Type II CRPS there is demonstrable nerve injury. Peripheral nerve entrapment is one of the components that contribute to severe, disproportionate pain in CRPS. Nerve hydrodissection is a perineural injection aimed to decompress the entrapped nerve. The objective of this case report is to evaluate the effect of nerve hydrodissection in pain management for CRPS.
A 38-year-old gentleman who presented to Advanced Pain Care Rehabilitation (APCR) clinic with severe left foot pain that persisted for more than a year after sustaining open fracture distal third left tibia and fibula with anterior tibialis tendon cut two years ago. Clinically, he met the IASP diagnostic criteria for CRPS. Pharmacological treatment with gabapentin, pregabalin and tramadol failed to alleviate his pain. His severe pain limits the use of physical modalities and desensitization technique. Thus, hydrodissection of left common peroneal nerve (CPN) was done for pain relief. Hydrodissection of left CPN done with 1cc 1% lignocaine HCl (50mg in 5ml), and 10cc dextrose 5% with ultrasound guidance. Left CPN was chosen because clinically the pain mainly involved distribution of this nerve. Pain relief effect is measure by Numerical Rating
Scale (NRS). The procedure reduced the pain from NRS 10 to 7.
Nerve hydrodissection is a treatment option for neuropathic pain management in CRPS with clinical evidence of nerve entrapment.