ADVANCING MESOTHERAPY: THE ROLE OF ULTRASOUND GUIDANCE IN IMPROVING SAFETY AND EFFECTIVENESS ACROSS AGE GROUPS

S. Sorrenti¹, M. Ciuffreda¹, E. Pisello¹, C. Pellegrino², A. Monacelli², G. Cucè³, C. Piangatelli¹, D. Galante⁴ | ¹Department of Anesthesiology, Intensive Care and Pain Management, AST Ancona, Fabriano (AN), Italy; ²Department of Anesthesiology, Intensive Care and Pain Management, Marche Polytechnic University, Ancona, Italy; ³Department of Public Health, University of Messina, Italy; ⁴Department of Anesthesiology, Intensive Care and Pain Management, ASL Foggia, Cerignola (FG), Italy

Abstract

Background and Aims. Antalgic mesotherapy is a minimally invasive outpatient technique widely used for the treatment of localized musculoskeletal pain, including tendinopathies, bursitis, low back pain, post-traumatic conditions, muscle pain, and tension-type headaches. The procedure consists of intradermal injections of pharmacological agents using short, fine needles. Although generally considered safe and simple to perform, conventional mesotherapy remains highly empirical, as it does not allow direct visualization of needle placement or drug diffusion. This may lead to suboptimal efficacy and an increased risk of adverse events, especially in the presence of anatomical variability or altered skin morphology. The aim of this study is to describe and evaluate the feasibility, safety, and potential advantages of ultrasound-guided antalgic mesotherapy in both adolescent and adult patients with thoracolumbar muscle pain.
Methods. Ultrasound-guided mesotherapy was performed in 20 patients: 10 adolescents (14–16 years; 5 males, 5 females) and 10 adults (6 males, 4 females), all presenting with thoracolumbar muscle-related pain requiring antalgic treatment. After informed consent was obtained, patients were positioned appropriately, and the treatment area was disinfected under sterile conditions. A preliminary ultrasound evaluation was conducted using a high-frequency linear probe to assess skin layers, identify critical anatomical structures (e.g., vessels), and accurately locate the dermis. Mesotherapy was then performed with a 4 mm single needle using an out-of-plane ultrasound-guided approach. Pharmacological agents were selected according to clinical indication and included non-particulate steroids (dexamethasone), local anesthetics (lidocaine), and ozone. Real-time ultrasound visualization allowed monitoring of drug diffusion within the dermal layer. A sterile dressing was applied at the end of the procedure.
Results. Ultrasound guidance enabled precise identification of skin layers and ensured accurate intradermal needle placement in all patients. Real-time visualization of drug spread confirmed appropriate dermal distribution of the injected substances. The technique was well tolerated in both adolescent and adult populations and did not significantly increase procedural time compared to conventional mesotherapy. No major adverse events were observed. Minor local reactions, when present, were self-limiting. The ability to visualize anatomical variations and avoid critical structures, such as blood vessels, enhanced procedural safety. Furthermore, the use of a single needle under ultrasound guidance allowed better adaptation to different anatomical regions and skin characteristics, potentially reducing inconsistent drug distribution associated with blind or multi-injector techniques.
Conclusions. Ultrasound-guided antalgic mesotherapy appears to be a feasible, safe, and reproducible technique that may overcome the empirical limitations of the conventional blind approach. Direct visualization of needle placement and real-time monitoring of drug diffusion improve procedural accuracy, optimize therapeutic effectiveness, and may reduce the incidence of adverse events. The method is applicable in both pediatric and adult patients, does not require advanced ultrasound expertise, and can be easily integrated into routine clinical practice without significant time burden. Although further controlled studies are needed to confirm its superiority over the traditional technique, ultrasound guidance may represent a meaningful innovation in mesotherapy, enhancing both safety and clinical outcomes.