Background & Aims
Carpal tunnel syndrome (CTS) caused by Increased pressure in the carpal tunnel with regard to gradual ischemia and damage of the median nerve (MN).CTS can be treated with non-surgical (analgesics, wrist splint, corticosteroid injection, physiotherapy, and extracorporeal shockwave) and surgical interventions.
Corticosteroid like triamcinolone was the most used injectate for perineural injection under blind or ultrasound-guided technique in patients with CTS.Perineural injection of dextrose is a new treatment modality use. 5% dextrose (DSW) has been used in such cases because D5W possesses osmolarity similar to that of normal saline.
PRIMARY OBJECTIVE
1.Evaluation of the analgesic effect of 5% dextrose versus triamcinolone injection for carpel tunnel syndrome patients.
SECONDARY OBJECTIVE
1.Efficiency of non surgical methods like hydrodissection in patients of mild to moderate cases of CTS.
2.To study the neurotoxic side effects of corticosteroid
Methods
A prospective, randomised, double blind study was conducted on 50 patients during year 2021- 2024. All eligible patients was identified & divided into two groups of 25 each. Written informed consent was taken from each participant.
After getting clearance from Institutional ethical committee(IECJNMC/790) and CTRI trial registration number(CTRI/2024/01/061292)
Patients of group A(25 patients) was administered one session of perineural injection with 5cc D5W
Patients of group B(25 patients) was administered with one session of perineural injection with 3cc triamcinolone acetonide mixed with 2 cc normal saline under ultrasound guidance.
Both the groups were assessed prior to injection and 1,3, and 6 week after the injection.
A proforma was prepared as per the assessment scoring system and patient’s pain status was assessed using Visual Analog Scale and score from Boston carpal tunnel syndrome questionnaire.
Results
In respective groups it is found out that group A which received D5W injection show improvement for short duration(up to 3weeks) and relapse rate is higher(5 out of 25). while in group B received triamcinolone shows better analgesia and relapse rates are low (1 out of 25)and patients have long duration of analgesia(up to 6 weeks).
for visual analog scale analgesic score more than 5 (p value is 0.39)
for BCTQ(symptom scale) score less than 23(p value is 0.09)
for BCTQ(functional scale) score less than 16 (p value is 0.25)
Other findings females are more prone for neuropathies among 50 patients 45 are females.
Most susceptible age group is 51-60 years.In our study we also find out that patients have neuropathy majorly in their dominant hand.
One patient from steroid group also have complain of severe tingling sensation& muscle power loss in palm as a side effect of steroids but it improve after regular physiotherapy sessions
Conclusions
We conclude from our data is that triamcinolone is better drug as compare to 5% dextrose in analgesic effect and low relapse rate and long term effectiveness in patients of mild to moderate carpal tunnel syndrome patients
References
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Presenting Author
Dewanshi Agrawal
Poster Authors
Dewanshi Agrawal
MD
Jawaharlal Nehru medical college, Aligarh Muslim university, aligarh
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral