Local injection therapy for carpal tunnel syndrome: a network meta-analysis of randomized controlled trial

Abstract

Objective: Clinical research has shown that local injections for carpal tunnel syndrome reduce the symptoms of patients and enhance their quality of life considerably. However, there are several therapy options, and the optimal choice of regimen remains uncertain. Therefore, we comprehensively evaluated the variations in clinical efficacy and safety of several medications for treating carpal tunnel syndrome.Methods: Computer searches of Embase, PubMed, Cochrane Library, and Web of Science databases were used to collect articles of randomized controlled trials on local injections for treating carpal tunnel syndrome from database creation till 10 June 2023. Two researchers independently screened the literature, extracted information, evaluated the risk of bias in the included studies, and performed network Meta-analysis using Stata 17.0 software. Drug efficacy was assessed using symptom severity/function and pain intensity. Surface under the cumulative ranking curve (SUCRA) ranking was used to determine the advantage of each therapy.Results: We included 26 randomized controlled trials with 1896 wrists involving 12 interventions, such as local injections of corticosteroids, platelet-rich plasma, 5% dextrose, progesterone, and hyaluronidase. The results of the network meta-analysis showed the following: (i) symptom severity: at the 3-month follow-up, D5W combined with splinting (SUCRA = 95%) ranked first, and hyaluronidase (SUCRA = 89.6%) at 6 months; (ii) functional severity: either at the 3-month follow-up (SUCRA = 89.5%) or 6 months (SUCRA = 83.6%), iii) pain intensity: 5% dextrose in water combined with splinting was the most effective at the 3-month (SUCRA = 85%) and 6-month (SUCRA = 87.6%) follow-up.Conclusion: Considering the combination of symptoms/function and pain intensity, combining 5% dextrose in water with splinting is probably the treatment of choice for patients with carpal tunnel syndrome. It is more effective than glucocorticoids and no adverse effects have been observed.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022370525.

A Novel Ultrasound-Guided Bilateral Vagal Nerve Hydrodissection With 5% Dextrose Without Local Anesthetic for Recalcitrant Chronic Multisite Pain and Autonomic Dysfunction

“…To date, to the best of our knowledge, no other studies have evaluated the specific effects of hydrodissection on the VN or the direct effects of having D5W surrounding the VN. However, restoration of function in multiple peripheral nerves as a result of hydrodissection has been demonstrated in randomized trials of the cubital tunnel and carpal tunnel syndrome, and corroborated by meta-analyses of carpal tunnel syndrome trials [ 6 - 8 ]. The therapeutic effects are attributed to both the release of nerves from fascial restrictions as seen in a volume effect study [ 21 ], and the direct therapeutic properties of the injectate, D5W [ 17 , 18 ], which has been the primary injectate reported in recent literature due to its availability, safety, and consistent clinical performance [ 6 - 8 ].…”

“…Empirical observations of bilateral vagus nerve hydrodissection using D5W under continuous vital sign monitoring in other patients have not revealed any tendency to bradycardia. Notably, perineural injection with dextrose for other nerves appears to restore normal baseline function rather than “stimulate” nerves [ 6 , 8 ].…”

“…Nerve hydrodissection with dextrose 5% in water (D5W) of peripheral nerves is increasingly utilized for nerve dysfunction, particularly in the presence of entrapment, with multiple positive meta-analyses for its application in carpal tunnel syndrome [ 6 - 8 ]. Ultrasound-guided cervical sympathetic chain hydrodissection with D5W has been reported to treat chronic upper trunk pain [ 9 ].…”

Ultrasound-guided Gluco-puncture in the management of saphenous nerve entrapment in ultra-trail runner: A clinical case

“…This means that the mode of action of regional sugar water injections is peripheral and not central. Pain modulation is mainly achieved by intradermal [87] and US-guided perineural injections [88,89,90,91], functional improvement is achieved by giving injections into dysfunctional tissues such as muscles, fascia, tendons and ligaments [92,93,94]. Physicians who have no access to US, typically use landmark-guided or palpation-guided D5W or G5W injections.…”