Ultrasound-Guided Perineural Circumferential Median Nerve Block With and Without Prior Dextrose 5% Hydrodissection

Dufour, Éric; Donat, Nicolas; Jaziri, Souhail; Kurdi, Okba; Couturier, Christian; Dreyfus, Jean‐François; Fischler, Marc

doi:10.1213/ane.0b013e31825fa37d

Cited by 30 publications

(25 citation statements)

References 16 publications

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“…Although little statistical significance was observed in the network comparisons of SMDs between regenerative injections and other treatments, the trends of effect sizes were in accordance with those in the pairwise comparisons (Table S1). Low-concentration dextrose had been first studied as a solution for the hydro-location of the needle tip during regional anesthesia, revealing no decrease of block effect with additional use of D5W [38]. Later, several case reports were published on the potential utility of D5W injection in entrapment neuropathies [39,40].…”

Section: Discussionmentioning

confidence: 99%

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

et al. 2020

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This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections-including 5% dextrose (D5W) and platelet-rich plasma (PRP)-for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Ranking probabilities of the SMD of each treatment were acquired by using simulation. Ten studies with 497 patients and comparing five treatments (D5W, PRP, splinting, corticosteroid, and normal saline) were included. The results of the simulation of rank probabilities showed that D5W injection was likely to be the best treatment, followed by PRP injection, in terms of clinical effectiveness in providing symptom relief. With respect to functional improvement, splinting ranked higher than PRP and D5W injections. Lastly, corticosteroid and saline injections were consistently ranked fourth and fifth in terms of therapeutic effects on symptom severity and functional status. D5W and PRP injections are more effective than splinting and corticosteroid or saline injection for relieving the symptoms of CTS. Compared with splinting, D5W and PRP injections do not provide better functional recovery. More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.Pharmaceuticals 2020, 13, 49 2 of 17 factors of CTS include, but are not limited to, female sex, obesity, diabetes, and hypothyroidism [4,5]. The diagnosis of CTS is traditionally based on electrophysiological tests; however, ultrasonographic nerve cross-sectional area measurements have also recently emerged as useful alternatives [6]. The therapeutic algorism for CTS can be based on symptom severity, findings of electrophysiological tests, and responsiveness to non-surgical therapy. Conservative treatments for mild to moderate CTS include corticosteroid injection [7], splinting [8], and physiotherapy (like therapeutic ultrasound, exercise, and neural mobilization) [9,10]. In patients with moderate to severe symptoms and poor responsiveness to non-operative management, carpal tunnel release (CTR) is indicated [11]. However, the symptoms might persist in 3% to 20% of patients after CTR [12]. In recalcitrant cases, the physicians should consider surgical management, such as revision neuroplasty, neurolysis, and nerve reconstruction [12].Corticosteroids function as potent anti-inflammatory medications and have been widely used as the main injectate for treating CTS. A recent randomized controlled trial that recruited 234 patients with CTS demonstrated that a single corticosteroid injection was better than night splinting in terms of clinical effectiveness at six weeks post-injection [13]. The aforementioned result is consistent with that of a previous systematic review that revealed the s...

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Section: Discussionmentioning

confidence: 99%

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

et al. 2020

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“…Hence, treatment with dextrose is regarded as a regenerative injection. In contrast, D5W has often been used for nerve injection because it has a similar osmolality to normal saline and is generally recognized as harmless to nerve structures (Dufour et al, ; Tsui & Kropelin, ). Hypoosmolar dextrose (<10%) is presumed to inhibit the activation of capsaicin‐sensitive receptors (e.g., transient receptor potential vanilloid receptor‐1) and thus block the release of substance P and calcitonin gene‐related peptide, which are pronociceptive substances that contribute to neurogenic inflammation (Wei et al, ; Zamami et al, ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of perineural platelet‐rich plasma and dextrose injections for moderate carpal tunnel syndrome: A prospective randomized, single‐blind, head‐to‐head comparative trial

Shen

Chou

et al. 2019

J Tissue Eng Regen Med

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Recent studies demonstrated the utility of perineural injection with platelet-rich plasma (PRP) and 5% dextrose (D5W) as novel strategies for treatment of carpal tunnel syndrome (CTS). The present study comprised a prospective, randomized, singleblind, head-to head comparative trial to compare the 6-month outcome of perineural injection with PRP or D5W in patients with moderate CTS. Fifty-two patients with unilateral moderate CTS were enrolled and randomized into two groups: The PRP group received a single 3-cc perineural injection of PRP under ultrasound guidance, and dextrose group received a single 3-cc perineural injection of D5W under ultrasound guidance. The Boston Carpal Tunnel Syndrome Questionnaire score was used as the primary outcome. Secondary outcomes included cross-sectional area (CSA) of the median nerve and electrophysiological assessments. Evaluations were performed at baseline and at 1, 3, and 6 months postinjection. All patients (26 patients per group) completed the study. Compared with the dextrose group, the PRP group demonstrated significant reductions in Boston Carpal Tunnel Syndrome Questionnaire function at 3 months (p = .044), distal motor latency at 6 months (p = .028), and CSA at 3 and 6 months (p = .010 and.018, respectively). A single perineural injection of PRP reduced the CSA of the median nerve more effectively than injection of D5W at 3 and 6 months postinjection for patients with moderate CTS. KEYWORDS carpal tunnel syndrome, dextrose, perineural injection, peripheral nerve entrapment, platelet-rich plasma, regenerative

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“…The use of 5% dextrose water (D5W) as the primary injectate for perineural injection during hydrodissection in the presence of chronic pain, particularly neuropathic pain, is receiving increasing attention [ 8 – 12 ]. D5W is also considered for use as a coadministration injectate along with noxious agents such as chemotherapeutics [ 13 , 14 ] and microbiospheres [ 15 ] to decrease pain, as well as a means to separate nerves from fascia while decreasing the risk of anesthetic toxicity [ 16 ]. An independent-of-anesthetic analgesic potential of D5W has been demonstrated in a recent randomized controlled trial of epidural D5W injection versus saline injection for patients with back pain accompanied by either buttock or leg pain [ 17 ], with potential long-term efficacy suggested by long-term follow-up data in those patients [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

Lam

Reeves

Cheng

2017

BioMed Research International

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Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of 16 ± 12.2 months and the mean Numeric Pain Rating Scale (NPRS) 0–10 pain level of 8.3 ± 1.3. The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1% ± 9.8%. The pretreatment Numeric Pain Rating Scale score of 8.3 ± 1.3 improved to 1.9 ± 0.9 at 2 months after the last treatment. Patients received 3.8 ± 2.6 treatments over 9.7 ± 7.8 months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides cumulative pain reduction.

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Ultrasound-Guided Perineural Circumferential Median Nerve Block With and Without Prior Dextrose 5% Hydrodissection

Abstract: Performing an ultrasound-guided perineural circumferential hydrodissection with D5W into which LA is injected leaves nerve block outcome unchanged. The assumption that this procedure may reduce the risk of intravascular injection and systemic toxicity remains to be demonstrated.

Cited by 30 publications

References 16 publications

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

Comparison of perineural platelet‐rich plasma and dextrose injections for moderate carpal tunnel syndrome: A prospective randomized, single‐blind, head‐to‐head comparative trial

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

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