AB1570 MODERN TREATMENT OF ENTRAPMENT NEUROPATHIES, THE HYDROCHEMICAL NEUROLYSIS

Background Entrapment neuropathies (E.N) are frequent and often underdiagnosed leading to significant chronic pain functional impairment impede the quality of life. Commonly occur at fibro-osseous tunnels through which nerves course with various static dynamic factors. Imaging particularly ultrasound can identify an anatomical cause, detect signs nerve injury, assess its severity also aid in percutaneous treatment like our technique: “The hydrochemical neurolysis” (HCN). Objectives We present US-guided neurolysis E.N relieve, most cases, caused by peripheral compression consequences mechanical release decompression entrapped nerves. This technique involves using US (fast, accessible, reliable, cheap radiation-free) find guide a needle around cut scat tissue introduce fluid mechanically push scar ways from create separation between tissues. With 18 G , real dissection is performed liquid (normal saline) we complete hydrodissection. Methods Before performing HCN, survey imaging should be low or high resolution probes, depending on depth intervention. patient informed clearly consents. Technique: what I do. Patient positioning: positioned supine, sitting, prone posture according location treated. Different positions, pillows and/or pads used restrict movement during procedure provide comfort for physician. Identification, marking skin, disinfection local anesthesia. The entry point calculated based distance inclination angle skin surface target better optimal visibility tip. These settings variable superficial deep situation site then marked (with marker) as well projection level area cleaned prepared standard sterile technique. US-probe covered semi-transparent bag gel further analysis A 25 anesthetize 1% lidocaine, advanced under US-guidance intermittent injection anesthesia (and hydrolocation) until comes into contact epineurium. in-plan approach my favorite. Perineural Hydrolocalization, Adhesiolysis, Hydrodissection injections. (variable length treated) inject pressure 5-10 ml (mix normal saline lidocaine) compressed connective-fatty make end seen ( hydrolocation ), repeated duration procedure. Then same needle, 20-60 all over entire where it completely surrounding structures hydrodissection ). Adhesiolysis carried out when there hydro-dissection was not effective, this case scalpel needling varying directions nerve. After hydrodissection, corticosteroid (5-10 prednisolone acetate 125 mg) his anti-inflammatory anti-fibrotic effect. Results In practice, have least 70% good results 12 months, 20 25% require 2nd session maybe 10% will resort surgery. seem very interesting, much than simple infiltration avoids surgery many cases. Conclusion Success requires knowledge anatomy, US-imaging. HCN simple, safe, precise, rapid, effective E.N, great alternative Acknowledgements To anesthesiologist who trained me musculoskeletal more years ago patients trusted offer them best care. Disclosure Interests None Declared.