Ultrasound guided rhomboid plane hydrodissection for fascial adhesion

Authors: Emanuele Piraccini MD, Stefano Maitan MD


Erector spinae plane block ; Myofascial pain syndromeHydrodissection

To the Editor

We carefully read the very interesting report by Ueshima et al. on Ultrasound-guided interfascial hydrodissection for severe pain in mastitis and we would like to give our contribution to the discussion with our experience on a similar topic [1].

A 36 year old factory girl complained of severe pain located in the left dorsal paravertebral region from 2 years. At the beginning it was slightly dull and increased over the months and the years. General practitioner treated her with NSAIDs and physical therapy with modest and impermanent results. Now the pain was severe (NRS = 8) and the medical examination revealed a tout band along the paravertebral region 2 cm medial to the scapular border. We suspected a myofascial pain syndrome, but we did not find any tender point, thus we performed an ultrasound (US) examination with linear transducer (13–6 MHz, Mylab One, Esaote) and we found an adhesion between rhomboid and intercostal muscles.

We performed an ultrasound guided fascial hydrodissection between rhomboid and intercostal muscles. The patient was placed in lateral position with the affected side uppermost and the scapula was moved laterally, the ultrasound probe was placed in the sagittal plane at the T5–6 level, just 2 cm medial to the scapula, to identify the trapezius muscles, the rhomboid major muscles, and the intercostal muscles. A 22-gauge needle was inserted into the plane between the rhomboid major and the intercostal muscles in a cephalad to caudad direction. We injected levobupivacaine 50 mg and dexamethasone 4 mg within 15 ml of normal saline and we confirmed the appropriate spread with US.

The patient’s pain disappeared some minutes later and the 2 more weekly injections planned were not performed because the patients was still pain free. Consent for publication was obtained from the patient.

Rhomboid plane block has been as regional anesthesia technique for thoracic and lung surgery [2,3], our experience show that the hydrodissection of the plane could be useful to treat some uncommon chronic pain conditions.

Sources of funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors.

Reference: https://doi.org/10.1016/j.jclinane.2019.06.001