Ultrasound-Guided Hydrodissection of the Superficial Peroneal Nerve for Chronic Neuropathic Pain: A War Veteran’s Story

Abstract

Aim: This case report presents the application of ultrasound-guided hydrodissection of the superficial peroneal nerve to treat chronic refractory neuropathic pain, rated by the patient with an average intensity of 6/10 on the numerical rating scale. Materials & methods: Under ultrasound guidance, the nerve was identified compressed by a herniation of the peroneus brevis. An in-plane hydrodissection was performed using a solution of 10 ml of ropivacaine and methylprednisolone until the epineurium was entirely separated from the surrounding tissue. Results: At the 2-month follow-up, the patient reported a decrease of pain, which he rated a 2/10 on the numerical rating scale. At this point, night-time episodes of moderate pain persisted. The procedure was repeated and at the 6-month follow-up, the patient remained pain free. Conclusion: This case report suggests that consecutive ultrasound-guided hydrodissection techniques might be a valuable option in the treatment of superficial peroneal nerve entrapment neuropathy.

Plain language summary

Peripheral neuropathic pain is a debilitating pain condition. Management can be challenging and clinicians often rely on oral medications and surgical options. This case report presents the treatment of a case of longstanding, moderate-to-severe superficial peroneal nerve entrapment neuropathy due to a grenade explosion, with consecutive nerve hydrodissection using a solution containing an anesthetic and a corticosteroid. Immediately after the second procedure and at the 6-month follow-up the patient reported near-total relief.

Keywords::

• case report
• hydrodissection
• neuropathic pain
• pain medicine
• ultrasound

Author contributions

N Ferreira-Silva is the first author. He was the physician treating the patient and wrote the draft of the manuscript. J Galacho was also one of the physicians who provided treatment to the patient. He provided intellectual input to the final version of the manuscript to be submitted for consideration for publication. G Ferreira-Dos-Santos oversaw the treatment of the patient by the first author and provided technical input, guidance, and advice during the procedures. He contributed to the draft of the manuscript and the necessary revisions following the first peer-review process. SR Clendenen and MFB Hurdle provided intellectual and technical expertise during the preparation for the case. They also provided intellectual input for both the first and second versions of the manuscript, following the first peer-review process. All authors approved the final version of the manuscript, to be submitted for consideration for publication.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

The patient signed informed consent agreeing to the publication of this case report, along with the figures accompanying it, in Pain Management. The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.