Aim: This case report presents the application of ultrasound-guided hydrodissection of the superficial peroneal nerve to treat chronic refractory neuropathic pain, rated by the patient with an average intensity of 6/10 on the numerical rating scale. Materials & methods: Under ultrasound guidance, the nerve was identified compressed by a herniation of the peroneus brevis. An in-plane hydrodissection was performed using a solution of 10 ml of ropivacaine and methylprednisolone until the epineurium was entirely separated from the surrounding tissue. Results: At the 2-month follow-up, the patient reported a decrease of pain, which he rated a 2/10 on the numerical rating scale. At this point, night-time episodes of moderate pain persisted. The procedure was repeated and at the 6-month follow-up, the patient remained pain free. Conclusion: This case report suggests that consecutive ultrasound-guided hydrodissection techniques might be a valuable option in the treatment of superficial peroneal nerve entrapment neuropathy.
Keywords: case report; hydrodissection; neuropathic pain; pain medicine; ultrasound.
Peripheral neuropathic pain is a debilitating pain condition. Management can be challenging and clinicians often rely on oral medications and surgical options. This case report presents the treatment of a case of longstanding, moderate-to-severe superficial peroneal nerve entrapment neuropathy due to a grenade explosion, with consecutive nerve hydrodissection using a solution containing an anesthetic and a corticosteroid. Immediately after the second procedure and at the 6-month follow-up the patient reported near-total relief.