AB146. SOH26AB_0309. The effectiveness, safety, and best practices of ultrasound-guided nerve hydrodissection in the management of pain conditions: a systematic review

Background: Ultrasound-guided nerve hydrodissection (US-HD) is an emerging minimally invasive intervention used to separate compressed peripheral or spinal nerves from adjacent soft tissues using injectate under ultrasound visualization. Increasing clinical interest has led to expanding applications across neuropathic pain syndromes, particularly carpal tunnel syndrome (CTS) and cervical radicular pain. This systematic review evaluates the current evidence surrounding clinical effectiveness, safety, and evolving best-practice technique standards.

Methods: A structured literature search was conducted across PubMed, Embase, Google Scholar, and the Cochrane Library, focusing on studies published over the past 15 years. Eligible studies involved adult patients undergoing US-HD for neuropathic or nociceptive pain. Randomized controlled trials, cohort studies, case series, anatomical research, and systematic reviews were included. Seventeen studies met the inclusion criteria and were analysed with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.

Results: Across the included studies, US-HD demonstrated consistent improvements in pain reduction, function, and symptom severity in entrapment neuropathies. The strongest evidence supports its use in CTS, with growing support for cervical radicular pain and other peripheral nerve entrapments. Complication rates were low and predominantly mild, including transient pain or dizziness. Best-practice elements—including in-plane needle visualization, dextrose-based injectates, and real-time image confirmation—were identified, although methods remain heterogeneous.

Conclusions: US-HD appears to be a safe and effective therapeutic option for nerve entrapment-related pain and may offer a less invasive alternative to surgical decompression. However, standardization of technique, injectate formulation, and follow-up protocols is needed. Large, well-designed controlled trials are required to validate current findings and define optimal practice recommendations.

Keywords: Systematic review; hydrodissection; neuropathic pain; radicular pain; ultrasound