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