Hydro Dissection of the Sciatic Nerve for Chronic Phantom Limb Pain

Background: Phantom limb pain can occur after limb amputation (60% - 85%). It is a persistent pain after amputation. It is different to stump pain and phantom sensation. Hydro dissection is a minimally invasive technique involving injection of fluid to separate fascial layers and release entrapped nerves and tendons. Its use in chronic phantom limb pain has not been reported previously. Case Presentation: We present the case of an 81-year-old man who experienced chronic phantom limb pain twenty 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 at the right gluteal region was noted. Following this identification, hydro dissection with 5% dextrose (15 mls) was performed to separate the fascial layers, and address perineural inflammation around the sciatic nerve. Following this targeted hydro dissection, the patient experienced substantial improvement in pain in the distribution of the chronic phantom limb pain. At two month follow up there was continued improvement with substantial reduction in pain. No complications were reported. Conclusion: This case supports the use of hydro dissection technique in phantom limb pain. Hydro dissection offers an alternative to more invasive interventions and warrants further investigation in the management of chronic phantom limb pain.