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Randomized double‐blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients
Author(s) -
Wu YungTsan,
Ke MingJen,
Ho TsungYen,
Li TsungYing,
Shen YuPing,
Chen LiangCheng
Publication year - 2018
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25332
Subject(s) - carpal tunnel syndrome , medicine , triamcinolone acetonide , corticosteroid , randomized controlled trial , carpal tunnel , median nerve , surgery , visual analogue scale , anesthesia , saline
Objective Perineural injection with 5% dextrose (D5W) is a novel strategy in the treatment of carpal tunnel syndrome (CTS). In contrast, perineural injection with corticosteroid has been used for decades for treating CTS, but possible neurotoxicity has been a major concern. No studies investigating the comparative effects have been published so far. The authors performed a prospective, randomized, double‐blinded, head‐to‐head comparative trial to compare these two approaches for patients having mild‐to‐moderate CTS. Methods Fifty‐four participants with mild‐to‐moderate CTS were randomly divided into dextrose and steroid groups. The patients were administered 1 session of perineural injection with 5ml D5W (dextrose group) or 3ml triamcinolone acetonide mixed with 2ml normal saline (steroid group), under ultrasound guidance. A visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross‐sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection and 1, 3, 4, and 6 months postinjection. Results All patients (27 wrists per group) completed the study. Compared with the steroid group, the dextrose group exhibited a significant reduction in pain and disability through the 4th to the 6th month ( p < 0.01). Interpretation Our study demonstrates that perineural injection of D5W is more beneficial than that of corticosteroid in patients with mild‐to‐moderate CTS at 4 to 6 months postinjection. Ann Neurol 2018;84:601–610