Comparison of the efficacy of lidocaine and betamethasone dipropionate in carpal tunnel syndrome injection

Dernek, Bahar; Aydın, Tuğba; Koseoglu, Pinar Kursuz; Kesiktaş, Fatma Nur; Yeşilyurt, Tuğba; Dıraçoğlu, Demirhan; Aksoy, Cihan

doi:10.3233/bmr-150477

Cited by 8 publications

(6 citation statements)

References 38 publications

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“…Several RCTs have compared corticosteroid injection with either placebo injection (saline or local anesthetic) or with no treatment [34,[38][39][40][41][42][43][44]. Pooling data from three trials at short term (2 to 4 weeks) showed that the probability of improvement was 0.71 with corticosteroid and 0.31 with placebo corresponding with a relative risk of 2.2 (95% CI 1.6 to 3; 3 studies; 210 participants) [39,40,43].…”

Section: Do Corticosteroid Injections Work?mentioning

confidence: 99%

Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome

Karjalanen

Raatikainen

Jaatinen

et al. 2022

JCM

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Carpal tunnel syndrome (CTS) is the most common upper extremity compression neuropathy. Non-operative interventions are usually the first-line treatments, and surgery is reserved for those that do not achieve a satisfactory symptom state by non-operative means. This narrative review summarizes the current evidence regarding the efficacy of orthoses, corticosteroid injections, platelet-rich plasma injections, Kinesio taping, neurodynamic techniques, gabapentin, therapeutic ultrasound, and extracorporeal shockwave therapy in people with CTS. While many trials suggest small short-term benefits, rigorous evidence of long-term patient-important benefits is limited. To improve the utility of healthcare resources, research in this area should focus on establishing efficacy of each treatment instead of comparing various treatments with uncertain benefits.

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Section: Do Corticosteroid Injections Work?mentioning

confidence: 99%

Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome

Karjalanen

Raatikainen

Jaatinen

et al. 2022

JCM

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“…Subsequently, 121 studies were excluded, and 5 studies were added through searching for references. In all, 18 RCTs met the inclusion criteria ( Peters-Veluthamaningal et al, 2010 ; Ginanneschi et al, 2012 ; Karadaş et al, 2012 ; Atroshi et al, 2013 ; Bahrami et al, 2015 ; Wu et al, 2017c ; Dernek et al, 2017 ; Uzun et al, 2017 ; Raeissadat et al, 2018 ; Wu et al, 2018 ; Güven et al, 2019 ; Senna et al, 2019 ; Shen et al, 2019 ; Boonhong and Thienkul, 2020b ; Hsu et al, 2020 ; Chen et al, 2021 ; Forogh et al, 2021 ). We extracted the outcomes (changes in the visual analog scale, symptom severity scale, and functional status scale) for further data analysis in a short-term (before or near 12 weeks) follow-up period.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of platelet-rich plasma in the treatment of carpal tunnel syndrome: A network meta-analysis of different injection treatments

et al. 2022

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Purpose: Carpal tunnel syndrome (CTS) is a common form of median nerve compression in the wrist caused by focal peripheral neuropathy. Platelet-rich plasma (PRP) therapy could improve the healing ability by exposing the injured tissues to high concentrations of autologous growth factors. Our study aims to compare all injective treatments for CTS and assess the efficacy and priority of PRP therapy.Methods: We searched Medline, Embase, Web of Science, Cochrane databases, and Clinicaltrial.gov until 17 October 2022. We only included data from randomized controlled trials (RCTs) that evaluated PRP injection therapy or drug injection therapy. The included RCTs measured at least one of the following three outcomes with validated instruments: in the visual analog scale (VAS), symptom severity scale (SSS), and functional status scale (FSS).Results: Overall, 19 studies with 1,066 patients were included in this study. We used the SUCRA rankings to determine the merits of various therapies. In all, 5% dextrose injections were the best treatment strategy for the VAS (MD −1.22, 95% CI −2.66 to 0.23; SUCRA = 79.2%), followed by triamcinolone (high-dose) injections (MD −0.69, 95% CI −2.11 to 0.73; SUCRA = 62.7%) and PRP injections (MD −0.39, 95% CI −1.67 to 0.89; SUCRA = 60.0%). In the SSS, the most effective intervention was hydroxyprogesterone injections (MD −0.62, 95% CI −1.09 to −0.16; SUCRA = 91.0%). The SUCRA ranking of PRP was second only to steroids and estrogen (MD −0.39, 95% CI −0.60 to −0.18; SUCRA = 60.8%). In the FSS, the best regimen strategy was hydroxyprogesterone injections (MD 0.12, 95% CI −0.30 to 0.54; SUCRA = 99.5%), followed by triamcinolone (low-dose) injections (MD −0.02, 95% CI −0.54 to 0.49; SUCRA = 87.4%) and PRP injections (MD −0.26, 95% CI −0.43 to −0.09; SUCRA = 77.1%).Conclusion: PRP is an alternative choice for CTS treatment. PRP injection is second only to steroids and estrogen in the treatment efficacy of CTS, with a wide indication and safe outcome.

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“…To our knowledge, there are no prior studies comparing different corticosteroid doses in combination with hydrodissection in elderly patients. Dernek et al 45 studied 67 CTS patients diagnosed on the basis of physical examination and NCSs. Some received a blend of 0.5 mL normal saline solution and 0.5 mL lidocaine, while the rest received 1 mL betamethasone dipropionate.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, the authors suggested lidocaine injection was an excellent alternative to corticosteroid injection, without potential side effects. 45 Another randomized, placebo-controlled trial by Karadas et al in CTS patients was conducted in 2012. They enrolled 57 CTS patients, who were assigned to one of three groups: group 1 received 1 mL 0.09% normal saline, group 2 received 40 mg triamcinolone acetonide, and group 3 received 4 mL 1% procaine HCl.…”

Section: Discussionmentioning

confidence: 99%

Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial

Roghani¹,

Holisaz²,

Tarkashvand³

et al. 2018

CIA

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BackgroundCarpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS.MethodsWe conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I–III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment.ResultsIn total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III.ConclusionHydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation.

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Comparison of the efficacy of lidocaine and betamethasone dipropionate in carpal tunnel syndrome injection

Abstract: Considering the potential side effects of corticosteroid, lidocaine injection is a good alternative treatment of carpal tunnel syndrome instead of corticosteroids.

Cited by 8 publications

References 38 publications

Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome

Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome

Efficacy and safety of platelet-rich plasma in the treatment of carpal tunnel syndrome: A network meta-analysis of different injection treatments

Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial

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