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Hydrodissection

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Hydrodissection, Hydrodissect

  • See Also
  1. Regional Anesthesia
  • Definitions
  1. Hydrodissection
    1. Fluid injected to separate tissue planes under Ultrasound guidance
  • Indications
  1. Ultrasound Guided Skin Foreign Body Removal
  2. Nerve entrapment syndrome
  3. Regional Anesthesia (adjunct technique)
  • Contraindications
  1. See Regional Anesthesia
  • Technique
  1. Sterile site preparation
    1. Chlorhexidine (Hibiclens) or Povidone Iodine (Betadine)
    2. Drape the site
  2. Obtain injectable
    1. Anesthetic (e.g. Lidocaine, Ropivacaine, Bupivacaine)
      1. Example: Lidocaine 2% 4 ml
    2. Optional Diluent (D5W or Normal Saline)
      1. Example 6 ml D5W (added to the Lidocaine, for a total of 10 ml)
    3. Optional additional agents
      1. Hyaluronidase
      2. Platelet rich plasma
  3. Ultrasound
    1. Identify the target nerve (or other tissue)
    2. In-Plane needle approach is most common
  4. Advance the needle slowly
    1. Visualize the needle tip and direct the needle inferior to nerve
    2. Stop and redirect if the patient experiences nerve related pain or Paresthesias
    3. Slowly inject small amounts of fluid around the target tissue
      1. Start below or inferior to the nerve (deepest point)
      2. Partially withdraw the needle and redirect to a point superior to the nerve
  • References
  1. Warrington (2026) Crit Dec Emerg Med 40(9): 22-3
  2. Lam (2020) J Pain Res 13:1957-68 +PMID: 32801851 [PubMed]