Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review
Abstract
:1. Introduction
2. Perineural Injection Therapy (PIT) with 5% Dextrose Water (D5W)
2.1. Mechanism
2.1.1. Pharmacological Effect
2.1.2. Mechanical Effect (Hydrodissection)
2.1.3. Other Possible Neuroregenerative Effects
2.2. Determined Factors for Hydrodissection Effect
2.2.1. Guided Method
2.2.2. Injectate Content
2.2.3. Volume Effect
2.2.4. Cumulative Effect
3. Search Method
4. Result
5. Clinical Trials
5.1. CTS
5.2. Ulnar Neuropathy at the Elbow
5.3. Deep Nervous Structure
6. Case Report
6.1. Superficial Radial Nerve Entrapment
6.2. Radial Nerve Palsy
6.3. Supinator Syndrome
6.4. Meralgia Paresthetica
6.5. Superficial Peroneal Nerve Entrapment
6.6. Pronator Teres Syndrome
7. Clinical Pearls
- PIT with D5W using the ultrasound-guided short-axis approach to simultaneously dissect below and above the entrapment nerve was recommended. Furthermore, using the short-axis approach to initially expand the perineural space followed by the long-axis injection could be more comprehensive and effective than only short-axis injection alone. The short-axis approach is simply repeated by pivoting the transducer and the HD direction to the proximal and thence to the distal part of the most entrapped part of the nerve, using the same needle entry point [33,34];
- Although the optimal dosage and frequency of PIT with D5W for entrapment nerve remain unknown, 5 to 20 cc D5W per injection administered twice or thrice is suggested based on the entrapment site and severity. The recommended injection interval is 1–4 weeks, according to the prognosis;
- During injection, the patients showed increased numbness and tightness caused by the volume effect or HD-related dragging effect on the nerve. The numbness/tightness may persist for several minutes and progressively decline within one hour;
- In cases where the patient is afraid of pain, a skin numbing with local anesthesia at the puncture site is suggested. Local anesthesia deeply into the nerve is not recommended because of the adverse effects of temporary nerve paralysis and possible neural toxicity [61].
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author (Year) | Study Design | Inclusion Criteria | Injection Method | Participant Characteristics | Outcome Measurements | Follow-Up | Safety Outcome | ||||
---|---|---|---|---|---|---|---|---|---|---|---|
Treatment Allocation | Disease | Sample Size | Mean Age (Years) | Female (%) | Symptom Duration (Months) | ||||||
Wu (2017) | Randomized, double-blind trial | Clinical + EDS | Single UG injection (ulnar S-I below and above MN) | Mild to moderate CTS | 30/30 (Wrists, cases/controls) | 58.4/58.1 (Cases/controls) | 86.7/80 (Cases/ controls) | 44.5/44.4 (Cases/controls) | VAS, BCTQ, EDS, CSA of MN, Global assessment of treatment results | 6 months | No AE reported |
5 mL D5W vs. 5 mL NS | |||||||||||
Lam (2018) | Retrospective study | Clinical | Mean 3.8 UG injection with 20–30 mL D5W (S-O then L-I above and below stellate ganglion, brachial plexus, cervical nerve roots) | Cervical root compression, Thoracic outlet syndrome, Cervicogenic headache | 26 | NA | NA | 46 months | Numeric Pain Rating Scale |
9.7 ± 7.8 months | No AE reported |
Wu (2018) | Randomized, double-blind trial | Clinical + EDS | Single UG injection (ulnar S-I below and above MN) | Mild to moderate CTS | 27/27 (Wrists, cases/controls) | 58.6/54.3 (Cases/controls) | 81.4/77.7 (Cases/controls) | 46.8/45.6 (Cases/controls) | VAS, BCTQ, EDS, CSA of MN, global assessment of treatment results | 6 months | No AE reported |
5 mL D5W vs. 3 mL triamcinolone (10 mg/mL) + 2 mL NS | |||||||||||
Chen (2020) | Randomized, double-blind trial | Clinical + EDS | Single UG injection (S-I below and above UN) | Mild to moderate UNE | 17/16 (Elbows, cases/controls) | 55.5/56.5 (Cases/controls) | 70.6/62.5 (Cases/ controls) | 44.4/41.6 (Cases/controls) | VAS, DASH, EDS, CSA of UN, global assessment of treatment results | 6 months | No AE reported |
5 mL D5W vs. 3 mL triamcinolone (10 mg/mL) + 2 mL NS | |||||||||||
Lin (2020) | Randomized, double-blinded, three-arm trial | Clinical + EDS | Single UG injection (radial S-I below and above MN) | CTS (NR grade) | 21/21/21 (Wrists, cases/controls) | 58.4/55.2/60.3 (Cases/controls) | 95.2/81/81 (Cases/ controls) | 54.4/20.6/49.8 (Cases/controls) | VAS, BCTQ, Q-DASH, EDS, and CSA of MN | 6 months | No AE reported |
4 mL D5W Vs. 2 mL D5W V. 1 mL D5W | |||||||||||
Lin (2021) | Randomized, double-blinded, three-arm trial | Clinical + EDS | Single UG injection (radial S-I below and above MN) | CTS (NR grade) | 17/14/14 (Wrists, cases/controls) | 56.9/52.9/59.2 (Cases/controls) | 94.1/85.7/85.7 (Cases/ controls) | 66/21.9/58.4 (Cases/controls) | mobility, shear-wave elastography CSA of MN, VAS, BCTQ | 6 months | NR |
4 mL D5W Vs. 2 mL D5W Vs. 1 mL D5W | |||||||||||
Li (2021) | Retrospective study | Clinical + EDS | Mean 2.2 UG injections with 10 mL D5W (ulnar S-I below and above MN + L-I from proximal to distal) | All grade CTS | 185 (wrists) No control | 55.4 | 65.4 | 30.8 | VAS Surgical rate | At least 1 year (1–3 years) post injection (mean 15.8 months) | No AE reported |
Author (Year) | Injection Method | Participant Characteristics | Outcome Measurements | Follow-Up | ||
---|---|---|---|---|---|---|
Diagnosis | Age (Year)/Sex | Symptom Duration | ||||
Chang (2015) | Two UG injections with 2 mL D5W (S-I above superfical radial nerve) |
Superficial radial nerve entrapment | 73/Female | 6 months | Symptom | Post 2 injections but NR of injection interval |
Chen (2018) | Two UG injections with 15 mL D5W (S-I below and above radial nerve + L-I from distal to proximal) | Radial nerve palsy | 62/Female | 2 months | Symptom, EDS, CSA of nerve | 3 months |
Chen (2018) | Single UG injection with 5 mL D5W (S-I above posterior interosseous nerve) | Supinator syndrome | 58/Male | 3–4 months | Muscle strengths | 1.5 months |
Su (2020) | Seven UG injections with 10 mL D5W (S-I below and above lateral femoral cutaneous nerve + L-I from distal to proximal) | Meralgia paresthetica | 35/Female | 20 years | Symptom, EDS, CSA of nerve | 6 months |
Su (2020) | Three UG injections with 15 mL D5W (S-I above and below radial nerve at two-week intervals) | Radial nerve palsy | 31/Male | 2 months | Symptom, EDS, CSA of nerve, shear-wave elastography | 21 months |
Six UG injections with 60 mL D5W (S-I above and below radial nerve at two-week intervals) | 43/Male | 2 years | 2 years | |||
Wei (2020) | Six UG injections with D5W (unknown dosage) (S-I above superfical radial nerve at one-month intervals) | Superfical radial nerve entrapment | 42/Female | 2 years | Symptom | 6 months |
Chiang (2020) | Single UG injection with 5 mL D5W (S-I above superfical peroneal nerve) | Superfical peroneal nerve entrapment | 58/Female | 4–5 months | Symptom | 6 months |
Chang (2021) | Five UG injections with 10 mL D5W (L-I above median nerve at two-week intervals) | Pronator teres syndrome | 25/Male | 6 months | Symptom | Post 5 injections |
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Wu, Y.-T.; Wu, C.-H.; Lin, J.-A.; Su, D.C.-J.; Hung, C.-Y.; Lam, S.K.H. Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review. Int. J. Mol. Sci. 2021, 22, 12358. https://doi.org/10.3390/ijms222212358
Wu Y-T, Wu C-H, Lin J-A, Su DC-J, Hung C-Y, Lam SKH. Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review. International Journal of Molecular Sciences. 2021; 22(22):12358. https://doi.org/10.3390/ijms222212358
Chicago/Turabian StyleWu, Yung-Tsan, Chueh-Hung Wu, Jui-An Lin, Daniel Chiung-Jui Su, Chen-Yu Hung, and Stanley K. H. Lam. 2021. "Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review" International Journal of Molecular Sciences 22, no. 22: 12358. https://doi.org/10.3390/ijms222212358