AB143. SOH26AB_0138. Hydrodissection for treatment of post-sternotomy pain syndrome: a case report

Background: Post-sternotomy pain syndrome is chronic pain (minimum 2 months) after surgical sternotomy. Its exact cause is not yet delineated, despite a reported prevalence in up to 66% of patients. Entrapment neuropathy due to scars, adhesions, or sutures is a suggested cause. Hydrodissection is a therapeutic technique wherein 5% dextrose or 0.9% saline is injected in a trajectory which separates fascial layers. This results in adhesiolysis, relief of pressure on the affected nerve, and localised inflammation, thought to encourage nerve regeneration. It is utilised to treat neuropathic pain and compression-related syndromes. In this case report, hydrodissection was used as a novel treatment for post-sternotomy pain syndrome, which has not previously been reported.

Case Description: We present the case of a 48-year-old male patient with a 3-year history of post-sternotomy pain syndrome affecting the left pectoral region. 5% dextrose (20 mL) was injected into the fascial layer between the pectoral muscles using an in-plane ultrasound-guided approach. Patient response was assessed 2 months post-treatment. The patient reported feeling an analgesic improvement. Functional outcomes, including range of motion and daily activities, improved substantially. No complications were reported.

Conclusions: Hydrodissection for treatment of post-sternotomy pain syndrome is a novel technique which shows promising results. It led to reduced analgesia requirement and facilitated physical activity. Hydrodissection offers an alternative to analgesics and more invasive interventions and warrants further investigation in the management of post-sternotomy pain syndrome.

Keywords: Hydrodissection; pain syndrome; sternotomy; ultrasound; case report