The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review

Background: Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Ultrasound-guided injection technique using a range of injectates to mechanically release and decompress the entrapped nerves has therefore developed called hydrodissection or perineural injection therapy. Several different injectates from normal saline, local anesthetics, corticosteroids, 5% dextrose in water (D5W), and platelet-rich plasma (PRP) are available and present clinical challenges when selecting agents regarding effectiveness and safety.Aims: To systematically search and summarize the clinical evidence and mechanism of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment.Methods: Four databases, including PubMed, EMBASE, Scopus, and Cochrane were systematically searched from the inception of the database up to August 22, 2020. Studies evaluating the effectiveness and safety of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment were included. Injectate efficacy presents clinical effects on pain intensity, clinical symptoms/function, and physical performance, electrodiagnostic findings, and nerve cross-sectional areas. Safety outcomes and mechanism of action of each injectate were also described.Results: From ten ultrasound-guided hydrodissection studies, nine studies were conducted in carpal tunnel syndrome and one study was performed in ulnar neuropathy at the elbow. All studies compared different interventions with different comparisons. Injectates included normal saline, D5W, corticosteroids, local anesthetics, hyaluronidase, and PRP. Five studies investigated PRP or PRP plus splinting comparisons. Both D5W and PRP showed a consistently favorable outcome than those in the control group or corticosteroids. The improved outcomes were also observed in comparison groups using injections with normal saline, local anesthetics, or corticosteroids, or splinting. No serious adverse events were reported. Local steroid injection side effects were reported in only one study.Conclusion: Ultrasound-guided hydrodissection is a safe and effective treatment for peripheral nerve entrapment. Injectate selection should be considered based on the injectate mechanism, effectiveness, and safety profile.

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469 NEUROPATHIC PAIN OF CANCER ORIGIN MIMICKING THE PERIPHERAL NERVE ENTRAPMENT NEUROPATHY - REPORT OF FOUR CASES

European Journal of Pain ◽

10.1016/s1090-3801(06)60472-2 ◽

2006 ◽

Vol 10 (S1) ◽

pp. S124c-S125

Author(s):

L. Navratil

Keyword(s):

Neuropathic Pain ◽

Peripheral Nerve ◽

Nerve Entrapment ◽

Entrapment Neuropathy

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Classical syndromes in occupational medicine. Peripheral nerve entrapment syndromes and ergonomic factors

American Journal of Industrial Medicine ◽

10.1002/ajim.4700040508 ◽

1983 ◽

Vol 4 (5) ◽

pp. 661-681 ◽

Cited By ~ 73

Author(s):

Robert G. Feldman ◽

Rose Goldman ◽

W. Monroe Keyserling

Keyword(s):

Peripheral Nerve ◽

Occupational Medicine ◽

Nerve Entrapment ◽

Entrapment Syndromes

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Entrapment syndromes

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0072 ◽

2019 ◽

pp. 839-846

Author(s):

Grainne Bourke ◽

Mobin Syed

Keyword(s):

Peripheral Nerve ◽

Effective Treatment ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Management Strategies ◽

Treatment Strategies ◽

Nerve Entrapment ◽

Cubital Tunnel ◽

Meralgia Paraesthetica ◽

Entrapment Syndromes

Peripheral nerve entrapment is common. Patients present with tingling and pain in the distribution of the affected nerve. This will progress to altered sensation and weakness with prolonged and/or increasing pressure. The most common nerve entrapment syndromes are carpal tunnel affecting the median nerve at the wrist and cubital tunnel affecting the ulnar nerve at the elbow. They affect the working population, so time-efficient diagnosis and robust effective treatment strategies are important to minimize the financial implications to industry. Aetiology, diagnosis, and management strategies for carpal tunnel, cubital tunnel, and meralgia paraesthetica are discussed in this chapter along with a brief overview of other entrapment syndromes. Current controversies between open and endoscopic carpal tunnel release are also reviewed.

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Surgical Treatment for Peripheral Nerve Entrapment Neuropathy

Japanese Journal of Neurosurgery ◽

10.7887/jcns.27.307 ◽

2018 ◽

Vol 27 (4) ◽

pp. 307-316

Author(s):

Kyongsong Kim ◽

Toyohiko Isu ◽

Daijiro Morimoto ◽

Rinko Kokubo ◽

Naotaka Iwamoto ◽

...

Keyword(s):

Surgical Treatment ◽

Peripheral Nerve ◽

Nerve Entrapment ◽

Entrapment Neuropathy

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A Review of the Management of Peripheral Nerve Entrapment Syndromes

Neurosurgery Quarterly ◽

10.1097/00013414-199612000-00001 ◽

1996 ◽

Vol 6 (4) ◽

pp. 225-250

Author(s):

Kevin O. Lillehei

Keyword(s):

Peripheral Nerve ◽

Nerve Entrapment ◽

Entrapment Syndromes

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Ultrasound-Guided Peripheral Nerve Blocks Performed by Orthopedic Surgeons: A Retrospective, Multicenter Study in Akita Prefecture, Japan

Advances in Orthopedics ◽

10.1155/2021/5580591 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Tatsuru Tomioka ◽

Seietsu Senma ◽

Yuichiro Narita ◽

Masakazu Urayama ◽

Satoshi Yumoto ◽

...

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Rural Areas ◽

Local Anesthetics ◽

Anesthetic Technique ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Orthopedic Surgeons ◽

Akita Prefecture

The shortage of doctors is a societal problem, especially in rural areas such as Akita Prefecture, Japan. Therefore, it is not unusual in Akita for orthopedic surgeons to perform upper and lower limb surgeries under ultrasound-guided peripheral nerve blocks managed by the operators themselves. Multicenter studies of ultrasound-guided peripheral nerve blocks performed by orthopedic surgeons have not been reported. The purpose of this study was to clarify the safety and reliability of ultrasound-guided peripheral nerve blocks performed by orthopedic surgeons in Akita. A total of 1,674 upper extremity surgery cases operated under ultrasound-guided peripheral nerve blocks at 8 hospitals in Akita prefecture from April 2016 to April 2018 were investigated retrospectively. These blocks were performed by a total of 37 orthopedic surgeons, including senior surgeons and residents. In 321 of the 1,674 cases (19%), local anesthetics were added to the surgical field. Two cases with special factors were converted to general anesthesia. There were 2 cases of complications associated with the nerve block, but they were all transient and recovered promptly. The block site and the hospital where the block was performed showed a significant relationship with the addition of local anesthetics to the surgical site ( P < 0.001 ). Surgery time, age at surgery, and surgical site showed no significant relationships with the addition of local anesthetics. The volume of the anesthetic used for the nerve block showed a significant inverse relationship with the addition of local anesthetics ( P = 0.040 ). Many orthopedic surgeons in Akita prefecture began to perform ultrasound-guided peripheral nerve blocks, which had a reliable anesthesia effect with no noticeable complications, whether performed by residents or senior orthopedic surgeons, and this is a useful anesthetic technique for orthopedic surgeons.

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