AB269. SOH26AB_0080. Phantom limb pain and sciatic nerve hydrodissection: a case report

Background: Phantom limb pain can occur after limb amputation (50–80%). It is a persistent pain after amputation. It is different to stump pain and phantom sensation. Hydrodissection is a minimally invasive technique involving the injection of fluid to separate fascial layers and release entrapped nerves and tendons. Its use in chronic phantom limb pain has not been reported.

Case Description: We present the case of an 81-year-old man who experienced chronic phantom limb pain 20 years after right lower limb amputation with hip disarticulation. Multiple analgesic options had been tried unsuccessfully. A theatre-based procedure using ultrasound guidance with a curvilinear 6 MHz ultrasound probe was undertaken. Markedly increased echolucency of the fascial plane around the sciatic nerve in the right gluteal region was noted. Following this identification, hydrodissection with 5% dextrose (15 mL) was performed to separate the fascial layers and address perineural inflammation around the sciatic nerve. Following this targeted hydrodissection, the patient experienced substantial improvement in pain in the distribution of the chronic phantom limb pain. At 2 months of follow-up, there was continued improvement with a substantial reduction in pain. No complications were reported.

Conclusions: This case supports the use of the hydrodissection technique in phantom limb pain. Hydrodissection offers an alternative to more invasive interventions and warrants further investigation in the management of chronic phantom limb pain.

Keywords: Phantom limb pain; ultrasound; hydrodissection; lower limb amputation; case report