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Abstract

Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic condition marked by pain disproportionate to the initial trauma, often accompanied by hyperalgesia, allodynia, and autonomic dysfunction. It commonly follows surgery, trauma, or nerve injury. This case report highlights the use of ultrasound-guided hydrodissection with dextrose prolotherapy as a minimally invasive approach to managing CRPS secondary to nerve injury.
A 27-year-old male presented with persistent pain, paresthesia, hypersensitivity, and intermittent shock-like sensations from the left index finger radiating to the upper back, occurring after surgical wire removal for a finger fracture. Clinical and ultrasound findings supported the diagnosis of CRPS type II (causalgia) due to nerve injury. The patient was treated with ultrasound-guided perineural hydrodissection using 5% dextrose to reduce nerve adhesion and irritation. Pain was assessed using the Numeric Rating Scale (NRS) at baseline, one week post-procedure, monthly for 12 months, and at a 21-month follow-up. The patient demonstrated sustained improvement in pain and sensory function without complications.
This case illustrates the potential of ultrasound-guided dextrose hydrodissection as a safe and effective treatment for CRPS caused by nerve injury. Larger studies are warranted to validate its efficacy and elucidate underlying mechanisms.
Abbreviations: CRPS: Complex Regional Pain Syndrome, IPM: Interventional Pain Medicine, NRS: Numeric Rating Scale, ORIF: Open Reduction and Internal Fixation, NSAIDs: Nonsteroidal Anti-Inflammatory Drugs
Keywords: Complex Regional Pain Syndrome; dextrose prolotherapy; hydrodissection; interventional pain management; ultrasound-guided injection
Citation: Novy TCT, Kalia H, Tsai YCG.Novel treatment of complex regional pain syndrome using hydrodissection with dextrose prolotherapy. Anaesth. pain intensive care 2025;29(7):808-813. DOI: 10.35975/apic.v29i7.2973
Received:  Jul 12, 2025; Revised; August 27, 2025; Accepted: August 27, 2025