A dependable technique to deal with post-amputation ache stays elusive, however a brand new Northwestern Medication research carried out in collaboration with Ukrainian physicians means that hydrodissection – a easy process that injects fluid round nerves – could scale back residual limb ache and opioid dependence.
The research is the primary to guage hydrodissection for post-amputation ache, a situation affecting hundreds of thousands worldwide that’s notoriously tough to deal with.
Will probably be printed on Wednesday (Feb. 19) in Regional Anesthesia & Ache Medication.
Including hydrodissection to opioid therapy for post-amputation ache not solely seems to enhance ache outcomes, but additionally exhibits mental-health advantages.”
Dr. Steven P. Cohen, senior research creator, professor of anesthesiology and the vice chair of analysis and ache drugs, Northwestern College Feinberg Faculty of Medication
For younger veterans, discovering safer alternate options to opioids is very essential, mentioned Cohen, a retired U.S. Military colonel who traveled to Ukraine to assist arrange the research. Many face a excessive danger of opioid dependence as a consequence of extreme psychological trauma.
How the research was carried out
Scientists adopted 74 Ukrainian troopers and civilians who had undergone traumatic limb amputations as a consequence of battle accidents. Thirty-eight sufferers obtained hydrodissection alongside opioid remedy inside six months of amputation, whereas 36 obtained opioids alone.
The research confirmed that hydrodissection mixed with opioids offered higher ache aid and decreased opioid use. On a 0–10 ache scale, the hydrodissection group reported a median ache discount of 4 factors, in comparison with 3 factors for these on opioids alone – a big distinction thought-about clinically significant in most research.
Moreover, almost two-thirds of sufferers within the hydrodissection group decreased their opioid use, whereas solely about one-third of the opioid-only group did. Sufferers receiving hydrodissection additionally reported decrease anxiousness ranges. Nonetheless, its results on phantom limb ache and power ache have been extra restricted.
Findings are ‘extremely related to Individuals’
Publish-amputation ache is a significant problem for each veterans and civilians worldwide, typically stopping amputees from utilizing prosthetics and decreasing their high quality of life.
An estimated 100,000 Ukrainians have suffered war-related amputations since Russia’s full-scale invasion of Ukraine. Within the U.S., greater than 2 million individuals dwell with limb loss, a quantity that’s anticipated to rise sharply as a consequence of ageing populations and growing charges of diabetes and vascular illness.
“This analysis is extremely related to Individuals,” Cohen mentioned. “Trauma is the main reason behind upper-extremity amputations worldwide, and post-amputation ache impacts most amputees, limiting their reintegration into society.”
Hydrodissection is remarkably easy
Hydrodissection is an ultrasound-guided process the place fluid is injected into scar tissues round nerves to alleviate strain, scale back irritation and promote therapeutic. Whereas the method has proven promise for acute and neuropathic ache, its effectiveness for post-amputation ache, particularly, had not been beforehand studied.
“It is outstanding how easy and accessible this system is – requiring simply an ultrasound and a needle. It may be simply adopted by most neighborhood hospitals within the U.S.,” mentioned Cohen.
Returning to Ukraine
Given the challenges of conducting analysis throughout wartime, the research was exploratory, not managed. Nonetheless, Cohen intends to return to Ukraine this spring to launch new randomized trials targeted on novel remedies for post-amputation ache, traumatic mind harm, and PTSD – undeterred by the risks of working in a battle zone.
A veteran of 4 abroad excursions in assist of army operations and a father to a son at present serving within the infantry, Cohen can be analyzing information on botulinum toxin injections for amputees and analyzing how psychological well being elements, comparable to melancholy and anxiousness, affect phantom limb ache and restoration outcomes.
The Different Examine Authors are Dr. DMytro DMYTRIIEV Who’s a pioneer on the usage of hydrodissection for postMummputation Ache, Winnie L. Liu, Dr. Maksym Barsa, Dr. Andreii Khomenko, Dr. Andrei strokan and Dr. Paul F. Pasquina.
This analysis was partly supported by the U.S. Dept. of Protection and Uniformed Providers College, Division of Bodily Medication & Rehabilitation.
Supply:
Journal reference:
Dmytriiev, D., et al. (2025) Perineuromal hydrodissection for acute postamputation ache? An observational research in a time of battle. Regional Anesthesia & Ache Medication. doi.org/10.1136/rapm-2024-106307.
