The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review
Background: Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be vis...
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| Format: | Article |
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Frontiers Media S.A.
2021-03-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2020.621150/full |
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| author | Montana Buntragulpoontawee Ke-Vin Chang Timporn Vitoonpong Sineenard Pornjaksawan Kittipong Kitisak Surasak Saokaew Surasak Saokaew Surasak Saokaew Sukrit Kanchanasurakit Sukrit Kanchanasurakit Sukrit Kanchanasurakit Sukrit Kanchanasurakit |
| author_facet | Montana Buntragulpoontawee Ke-Vin Chang Timporn Vitoonpong Sineenard Pornjaksawan Kittipong Kitisak Surasak Saokaew Surasak Saokaew Surasak Saokaew Sukrit Kanchanasurakit Sukrit Kanchanasurakit Sukrit Kanchanasurakit Sukrit Kanchanasurakit |
| author_sort | Montana Buntragulpoontawee |
| collection | DOAJ |
| description | Background: Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Ultrasound-guided injection technique using a range of injectates to mechanically release and decompress the entrapped nerves has therefore developed called hydrodissection or perineural injection therapy. Several different injectates from normal saline, local anesthetics, corticosteroids, 5% dextrose in water (D5W), and platelet-rich plasma (PRP) are available and present clinical challenges when selecting agents regarding effectiveness and safety.Aims: To systematically search and summarize the clinical evidence and mechanism of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment.Methods: Four databases, including PubMed, EMBASE, Scopus, and Cochrane were systematically searched from the inception of the database up to August 22, 2020. Studies evaluating the effectiveness and safety of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment were included. Injectate efficacy presents clinical effects on pain intensity, clinical symptoms/function, and physical performance, electrodiagnostic findings, and nerve cross-sectional areas. Safety outcomes and mechanism of action of each injectate were also described.Results: From ten ultrasound-guided hydrodissection studies, nine studies were conducted in carpal tunnel syndrome and one study was performed in ulnar neuropathy at the elbow. All studies compared different interventions with different comparisons. Injectates included normal saline, D5W, corticosteroids, local anesthetics, hyaluronidase, and PRP. Five studies investigated PRP or PRP plus splinting comparisons. Both D5W and PRP showed a consistently favorable outcome than those in the control group or corticosteroids. The improved outcomes were also observed in comparison groups using injections with normal saline, local anesthetics, or corticosteroids, or splinting. No serious adverse events were reported. Local steroid injection side effects were reported in only one study.Conclusion: Ultrasound-guided hydrodissection is a safe and effective treatment for peripheral nerve entrapment. Injectate selection should be considered based on the injectate mechanism, effectiveness, and safety profile. |
| first_indexed | 2024-12-24T11:19:43Z |
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| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-24T11:19:43Z |
| publishDate | 2021-03-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-30108a4e22f34fc397de1f026682f4022022-12-21T16:58:16ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-03-011110.3389/fphar.2020.621150621150The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic ReviewMontana Buntragulpoontawee0Ke-Vin Chang1Timporn Vitoonpong2Sineenard Pornjaksawan3Kittipong Kitisak4Surasak Saokaew5Surasak Saokaew6Surasak Saokaew7Sukrit Kanchanasurakit8Sukrit Kanchanasurakit9Sukrit Kanchanasurakit10Sukrit Kanchanasurakit11Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandDepartment of Physical Medicine and Rehabilitation, National Taiwan University Hospital Bei-Hu Branch, Taipei, TaiwanDepartment of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandRehabilitation Clinic, Bangkok Hospital Chiang Mai, Chiang Mai, ThailandDepartment of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandDivision of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, ThailandCenter of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, ThailandUnit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, ThailandDivision of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, ThailandCenter of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, ThailandUnit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, ThailandDivision of Pharmaceutical Care, Department of Pharmacy, Phrae Hospital, Phrae, ThailandBackground: Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Ultrasound-guided injection technique using a range of injectates to mechanically release and decompress the entrapped nerves has therefore developed called hydrodissection or perineural injection therapy. Several different injectates from normal saline, local anesthetics, corticosteroids, 5% dextrose in water (D5W), and platelet-rich plasma (PRP) are available and present clinical challenges when selecting agents regarding effectiveness and safety.Aims: To systematically search and summarize the clinical evidence and mechanism of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment.Methods: Four databases, including PubMed, EMBASE, Scopus, and Cochrane were systematically searched from the inception of the database up to August 22, 2020. Studies evaluating the effectiveness and safety of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment were included. Injectate efficacy presents clinical effects on pain intensity, clinical symptoms/function, and physical performance, electrodiagnostic findings, and nerve cross-sectional areas. Safety outcomes and mechanism of action of each injectate were also described.Results: From ten ultrasound-guided hydrodissection studies, nine studies were conducted in carpal tunnel syndrome and one study was performed in ulnar neuropathy at the elbow. All studies compared different interventions with different comparisons. Injectates included normal saline, D5W, corticosteroids, local anesthetics, hyaluronidase, and PRP. Five studies investigated PRP or PRP plus splinting comparisons. Both D5W and PRP showed a consistently favorable outcome than those in the control group or corticosteroids. The improved outcomes were also observed in comparison groups using injections with normal saline, local anesthetics, or corticosteroids, or splinting. No serious adverse events were reported. Local steroid injection side effects were reported in only one study.Conclusion: Ultrasound-guided hydrodissection is a safe and effective treatment for peripheral nerve entrapment. Injectate selection should be considered based on the injectate mechanism, effectiveness, and safety profile.https://www.frontiersin.org/articles/10.3389/fphar.2020.621150/fullentrapment neuropathyultrasound-guided hydrodissectionperipheral nerveperineural injectioninjectatecarpal tunnel syndrome |
| spellingShingle | Montana Buntragulpoontawee Ke-Vin Chang Timporn Vitoonpong Sineenard Pornjaksawan Kittipong Kitisak Surasak Saokaew Surasak Saokaew Surasak Saokaew Sukrit Kanchanasurakit Sukrit Kanchanasurakit Sukrit Kanchanasurakit Sukrit Kanchanasurakit The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review Frontiers in Pharmacology entrapment neuropathy ultrasound-guided hydrodissection peripheral nerve perineural injection injectate carpal tunnel syndrome |
| title | The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review |
| title_full | The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review |
| title_fullStr | The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review |
| title_full_unstemmed | The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review |
| title_short | The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review |
| title_sort | effectiveness and safety of commonly used injectates for ultrasound guided hydrodissection treatment of peripheral nerve entrapment syndromes a systematic review |
| topic | entrapment neuropathy ultrasound-guided hydrodissection peripheral nerve perineural injection injectate carpal tunnel syndrome |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2020.621150/full |
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