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BioMed Research International
Volume 2017, Article ID 7920438, 17 pages
https://doi.org/10.1155/2017/7920438
Research Article

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

1Department of Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
2KH Lam Musculoskeletal Pain Management and Sports Injury Centre, Kowloon, Hong Kong
3The Hong Kong Institute of Musculoskeletal Medicine, Tsuen Wan, Hong Kong
4Private Practice PM&R and Pain Management, Roeland Park, KS, USA
5Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

Correspondence should be addressed to Stanley K. H. Lam; moc.liamg@hkmalrd

Received 16 December 2016; Revised 19 March 2017; Accepted 24 July 2017; Published 1 October 2017

Academic Editor: Jui-An Lin

Copyright © 2017 Stanley K. H. Lam et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 months and the mean Numeric Pain Rating Scale (NPRS) 0–10 pain level of . The mean 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 improved to at 2 months after the last treatment. Patients received treatments over 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.