Effectiveness and Safety of Ultrasound-Guided Nerve Hydrodissection in Pain Management

Objective: To evaluate current evidence on Ultrasound-guided nerve Hydrodissection (US-HD) for pain management. Methods: Comprehensive search of PubMed, Embase, Cochrane Library, Google Scholar (last 15 years, English only). Eligible studies included RCTs, cohort studies, case series, and cadaveric investigations. Results: 124 records identified; 17 studies met inclusion criteria. Evidence supports US-HD effectiveness for entrapment neuropathies (notably carpal tunnel syndrome, cervical radicular pain). Most studies showed significant pain and functional improvement, with low complication rates. Indirect evidence from anesthesia block studies supports procedural safety. Adverse events were rare and minor. Conclusion: The findings suggest that US-HD is a promising and minimally invasive intervention for peripheral and spinal nerve entrapments, particularly carpal tunnel syndrome and cervical radicular pain. Most studies reported significant improvements in pain relief and functional outcomes, with low complication rates. Adverse events were infrequent and generally minor, such as transient discomfort at the injection site. Best practice recommendations are beginning to emerge regarding ultrasound technique, needle approach, and injectate selection, with dextrose and local anaesthetic solutions most frequently described. Real-time ultrasound imaging allows precise needle placement, improved safety, and visualization of tissue planes, though techniques remain heterogeneous across studies. Overall, US-HD appears safe and effective, but current evidence is limited by small study sizes, variable protocols, and short follow-up. Larger randomized controlled trials are required to confirm efficacy, optimize technique, and standardize training.