Dextrose Injection Research Articles

Comparison of Autologous Blood Injection and Dextrose Prolotherapy in the Treatment of Chronic Recurrent Temporomandibular Dislocation: A Randomized Clinical Trial.

Prolotherapy is a minimally invasive technique that aims to functionally restore or repair the soft and hard tissues of the TMJ by injecting a stimulant. The present study was conducted to compare the effectiveness of dextrose and autologous blood injection (ABI) as prolotherapy agents in the treatment of patients with chronic recurrent TMJ dislocation (CRTD). Thirty-two patients were divided into two groups-ABI and dextrose (n = 16 each). The superior joint space was located by means of cantho-tragal line and lavage. Delivery of prolotherapy agent was performed by single-needle technique. An elastic bandage was applied for a week and rehabilitation was initiated three weeks after the treatment. Pain level, joint hypermobility, maximal mouth opening, and frequency of dislocations were recorded at various follow-up intervals up to one year post-treatment. No significant difference (p > 0.05) was seen for the values between both groups at all time intervals in the pain level. At the 6-month and annual follow-ups, the mouth opening of the patients treated with ABI was significantly lower (p < 0.01) as compared to those treated with dextrose. The patients treated with ABI therapy exhibited fewer dislocations (p < 0.05) within the following year. Prolotherapy is a relatively noninvasive, safer, and effective treatment modality with a high success rate for patients with CRTD. Both, ABI and dextrose, proved effective in reducing the pain and joint hypermobility associated with CTRDs within a week. ABI proved to be more efficient in reducing the mouth opening and limiting the dislocation of TMJ as compared to dextrose therapy.

A protocol for a randomized clinical trial assessing the efficacy of hypertonic dextrose injection (prolotherapy) in chronic ankle instability

BackgroundLateral ankle sprain (LAS) is a common injury. Conservative care is not uniformly effective. Chronic ankle instability (CAI) results in up to 70% of patients with LAS in the physically active population. LAS, together with subsequent osteochondral lesions and pain in many patients, leads to the development of post-traumatic osteoarthritis, resulting in a substantial direct and indirect personal and societal health burden. Dextrose prolotherapy (DPT) is an injection-based therapy for many chronic musculoskeletal conditions but has not been tested for CAI. This protocol describes a randomized controlled trial to test the efficacy of DPT versus normal saline (NS) injections for chronic ankle instability (CAI).Methods and analysisA single-center, parallel-group, randomized controlled trial will be conducted at a university-based primary care clinic in Hong Kong. A total of 114 patients with CAI will be randomly allocated (1:1) to DPT and NS groups. The primary outcome will be the Cumberland Ankle Instability Tool scores at 1 year. The secondary outcomes will be the number of re-sprains in 1 year, the Star Excursion Balance Test, the 5-level of EuroQol 5-dimension questionnaire, and the Foot and Ankle Ability Measure. All outcomes will be evaluated at baseline and at 16, 26, and 52 weeks using a linear mixed model.DiscussionWe hypothesized the DPT is a safe, easily accessible, and effective treatment for patients with CAI. This RCT study will inform whether DPT could be a primary non-surgical treatment for CAI.Trial registrationChinese Clinical Trial Registry ChiCTR2000040213. Registered on 25 November 2020.

Corticosteroid Versus Dextrose Ultrasound-Guided Injection in the Treatment of Sacroiliac Joint Dysfunction: A Randomized Double-Blinded Clinical Trial

Background: Sacroiliac Joint (SIJ) dysfunction, a common etiology of Low Back Pain (LBP), is a challenging diagnosis. There is controversy over the efficacy of prolotherapy and corticosteroid injections in relieving SIJ dysfunction. Inconsistent success rates reported in previous studies can be due to heterogeneity in selecting the patients and procedures between studies. This study was conducted to compare the efficacy of local injection of dextrose prolotherapy and corticosteroid in treating the SIJ dysfunction.&#x0D; Methods: This 36-week, double-blind, Randomized Controlled Trial (RCT) included 40 patients with SIJ dysfunction. The clinical impression was confirmed by the use of a diagnostic injection of local anesthetic inside SIJ. Participants received a single injection of either hypertonic dextrose solution or triamcinolone under Ultrasound (US) guidance. The primary outcome measurement tools, including the Visual Analog Scale (VAS) for pain and the Dallas Pain Questionnaire (DPQ), were evaluated initially and after 2, 8, and 36 weeks.&#x0D; Results: In both prolotherapy and corticosteroid groups, VAS significantly declined within 36-weeks of follow-up. However, there was no remarkable difference between the two groups at any follow-up timepoints. Similarly, DPQ revealed a remarkable improvement in the corticosteroid group while it did not show any meaningful change in the prolotherapy group.&#x0D; Conclusion: Both local injections of dextrose and corticosteroids can successfully reduce pain in patients with SIJ dysfunction without significant superiority between the two treatments. However, corticosteroid injection was slightly more effective in terms of improvement of functional status. Further investigations are required to extend these results to SIJ dysfunction treatment more reliably.

Prolotherapy, new non-surgical treatment for tempromandibular joint painful clicking and dislocation

Purpose prolotherpy is local injection of the affected joint with 5% Dextrose water (suger based solution) to the peri and intra tempromandibular joint( Disc,Ligaments,tendons) to treate the TMJ painfull clicking and chronic dislocation as conservative treatmentMethod:We have selected forty nine patient ,twenty nine of them suffering from painful clicking,and twenty suffering from chronic dislocation , So we started our treatment by giving them 3-5 local injection to the TMJ area, 7-10 days interval between each session with 8 months follow up.Results:The Dextrose injection stimulate formation new collagen fiber , These fibers appear much the same as normal tissue, except that they are thicker and stronger than normal tissue up to 40% this lead to lax tissue (capsule and the ligament) that will become stronger and repair the damage that will occur in these structures also it stimulate present cells and tissues to re-growth and rehabilitation of an important structure such as ligament, cartilage &amp; tendon of the weakened area, it's found that deposition of new collagen as it matures. The Dextrose injection 1- shrinkage the collagen fiber 2-tightens the ligament and tendons 3- strong it.Conclusion: The Dextrose injection formation of new collagen and strengthen and repair of the presented structures in the joint(tendon,ligament, disc and capsule) lead to disappear of the clicking and limit movement of the TMJ more for ward and prevent dislocation.

Comparative Colloidal Stability of Commercial Amphotericin B Nanoformulations Using Dynamic and Static Multiple Light Scattering Techniques.

Amphotericin B (AmB) nanoformulations have been widely used for the treatment of invasive fungal infections in clinical practice, all of which are lyophilized solid dosage forms that improve storage stability. The colloidal stability of reconstituted lyophilized nanoparticles in an injection medium is a critical quality attribute that directly affects their safety and efficacy during clinical use. In the present study, the colloidal stability of commercial AmB nanoformulations, including AmB cholesteryl sulfate complex (AmB-CSC) and AmB liposome (AmB-Lipo), was evaluated using the dynamic (DLS) and static multiple light scattering (SMLS) techniques. Compared to the DLS technique, the SMLS technique allows for a more objective and accurate evaluation of the colloidal stability of AmB nanoformulations. The results obtained using the SMLS technique demonstrated that AmB-CSC and AmB-Lipo exhibited excellent colloidal stability in both sterile water and 5% dextrose injection. The disk-like structure of the AmB-CSC nanoparticles more readily adsorbed serum proteins to form protein corona compared to the spherical structure of AmB-Lipo after incubation with serum. Additionally, AmB-CSC and AmB-Lipo can significantly reduce the in vitro cytotoxicity and in vivo nephrotoxicity of AmB, which may be attributed to the good colloidal stability and the improved pharmacokinetic profiles of AmB nanoformulations. To the best of our knowledge, this study is the first to compare the colloidal stability of commercial AmB nanoformulations. These findings will provide useful information not only to inform the clinical use of available AmB nanoformulations but also for improving the design and conduct of translational research on novel AmB nanomedicines.

Effect of Perineural Dextrose Injection on Myofascial Pain Syndrome

Background: Myofascial pain syndrome (MFPS) is defined as the motor, sensory, and autonomic signs resulting from trigger points (TrPs). Objectives: To assess the effectiveness of the perineural injection in patients with MFPS. Materials and methods: The study was conducted at AL Ramadi Teaching Hospital, Department of Rheumatology, Ramadi City, Iraq. The study period was from June 2019 to January 2021. A retrospective review of 100 patients with prospectively collected clinical and radiologic data was performed to evaluate the effectiveness of perineural injection on MFPS. A 3 ml of 5% dextrose solution was managed sub-cutaneous straight at the labeled chronic constrictive injury and tender spots rounding the knee. The VAS and WOMAC were calculated for each participant at the time of the presentation and 1, 3, and 6 months following treatment. Results: The mean age of the patients was 60.93 ± 6.17 years (25-70 years). Three-quarters (75/100) of the cases were female. Seventy subjects were from the age group ≥ 40 years, while the remaining 30 cases were from the age group < 40 years. Fifty-five cases were with right-sided involvement. Successful results were achieved in 90% of the participants. There were no statistically significant differences between the effective and not effective groups regarding the age, gender, and the involved side (P-value > 0.05). There was a reduction in the mean VAS (8.47 ± 0.77) of pain and WOMAC (78.99 ± 5.69) score at the time of presentation to 1.87 ± 1.32 for the VAS and 17.84 ± 4.66 WOMAC at 6-months post-injection period. No complications were reported in all patients apart from mild pain at the injection site. Conclusion: Perineural dextrose injection was successful in 90% of the patients with MFPS. This modality results in a sharp reduction of both VAS and WOMAC scores from the time of the presentation to 6-months post-treatment. We recommend using this modality because it is easy, effective, and safe.

Dextrose prolotherapy for chronic tendinopathy: A scoping review

Tendinopathy is a frequent source of musculoskeletal pain and disability. Between treatment options, prolotherapy, an injection treatment that aims to promote tissue healing, could play a role in symptomatic and functional improvement. The purpose of the study is to analyze current evidence about the effect of dextrose injections on clinical outcomes in patients with chronic tendinopathy. A literature search on MEDLINE (PubMed) and PEDro databases was conducted. All randomized controlled trials (RCTs) published in the last 10 years, with available abstracts, in English language, analyzing the effect of prolotherapy in human subjects with a diagnosis of chronic tendinopathy were considered. Methodological quality was assessed by PEDRO scale quality assessment tool. Sixteen papers were included. Most of the RCTs were of medium to high quality. Based on the analyzed data, prolotherapy could represent an easy to access, cheap, safe and effective conservative treatment in rotator cuff tendinopathy and in epiconodylosis and could improve pain control in the medium to long-term, with encouraging data on function restoring in the long term. However, solutions preparation, procedural aspects and comparators were highly heterogeneous. Current evidence suggests that prolotherapy can results in improving symptoms in patients with tendinopathy, with no observed adverse reactions. However, few RCTs have been conducted; the results are not enough consistent and a wide heterogeneity in protocols makes comparing data not always possible. Therefore, further studies requiring, first, a proposal of a repeatable standardized procedure are needed to confirm the positive preliminary results.

Dextrose Prolotherapy for Symptomatic Grade IV Knee Osteoarthritis: A Pilot Study of Early and Longer-Term Analgesia and Pain-Specific Cytokine Concentrations.

Neurocytokines may upregulate or downregulate neuropathic pain. We hypothesized that dextrose (D-glucose) injections for therapeutic purposes (dextrose prolotherapy: DPT) in painful knee osteoarthritis (KOA) would favorably affect synovial-fluid neurocytokine concentrations. Twenty participants with grade IV symptomatic KOA received synovial-fluid aspiration followed by dextrose or simulated dextrose injections, followed by the reverse after one week. All participants then received open-label dextrose injections monthly for 6 months, with serial assessments of walking pain at 20 min for 9 months, as well as synovial-neurocytokine-concentration measurements (calcitonin gene-related peptide, substance P (SP), and neuropeptide Y (NPY)) at one week and three months. Clinically important analgesia was observed at 20 min and for 9 months post dextrose injection. One -week synovial-fluid SP concentration rose by 111% (p = 0.028 within groups and p = 0.07 between groups) in the dextrose-injected knees compared to synovial-fluid aspiration only. Three-month synovial-fluid NPY concentration dropped substantially (65%; p &lt; 0.001) after open-label dextrose injection in all knees. Prompt and medium-term analgesia after intra-articular dextrose injection in KOA was accompanied by potentially favorable changes in synovial-fluid neurocytokines SP and NPY, respectively, although these changes were isolated. Including neurocytokines in future assessments of DPT to elucidate mechanisms of action is recommended.

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

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.

Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy

Both corticosteroids and hypertonic dextrose injections are commonly used for chronic supraspinatus tendinopathy. To compare the supraspinatus echogenicity and clinical effects of echo-guided hypertonic dextrose versus corticosteroid injection for treating chronic supraspinatus tendinopathy. Cohort study; Level of evidence, 3. The authors performed a secondary data analysis of a previous clinical trial including patients who received normal saline versus hypertonic dextrose injection; patients who received corticosteroid injection were recruited between August 2017 and July 2021. Baseline patient data were matched among these 3 groups at a 1:1:1 ratio. At baseline and 2, 6, and 12 weeks after the intervention, the authors compared morphological changes (supraspinatus thickness and echogenicity) and clinical parameters (visual analog scale [VAS] for pain, Shoulder Pain and Disability Index [SPADI], and range of motion [ROM]). Analysis of variance was used to compare mean changes from baseline among the groups. A total of 75 patients (25 in each group) were included. At 2-week follow-up, both the dextrose and the steroid groups exhibited improvement in VAS scores (mean difference [MD] from baseline: -2.0 in dextrose group; -3.3 in steroid group (P < .001)), SPADI scores (MD from baseline: -10.6 in dextrose group; -24.6 in steroid group (P < .001)), and flexion ROM (MD from baseline: 13.6° in dextrose group; 21.1° in steroid group) (P =.001). At 6 weeks after injection, the hypertonic dextrose group exhibited more favorable echogenic improvement in supraspinatus tendon morphology compared with the other 2 groups (P < .001). However, the steroid group showed significantly more improvement in clinical parameters compared with the other 2 groups at both week 6 (MD from baseline: VAS, -3.2; SPADI, -26.6; flexion ROM, 21.5°) and week 12 (MD from baseline: VAS, -2.5; SPADI, -20.4; flexion ROM, 15.2°) (P < .001 for all). Hypertonic dextrose injection improved supraspinatus echogenicity after 6 weeks but provided short-term symptomatic relief in the patients with chronic supraspinatus tendinopathy when compared with corticosteroid or saline injections. Steroid injection exerted a more favorable clinical effect at weeks 6 and 12 but demonstrated a negative effect on the supraspinatus.

Management of benign pancreatic pathology by endoscopic ultrasound-guided gastroenterostomy: Experience at our center

In the search for biologically active, disease-modifying treatment modalities for chronic pain, three forms of dextrose injection—prolotherapy, perineural injection therapy, and hydrodissection—have emerged as effective for many conditions. Each is discrete but related by the injectant (dextrose) and the clinical tradition from which each is derived. This chapter reviews the origins of dextrose-related injection therapy, outlines the basic science and clinical evidence behind each, and describes the role of ultrasound guidance in the clinical conduct of each.

THERAPEUTIC EFFECT OF COCKTAIL VS PROLOTHERAPY INJECTION IN CHRONIC PLANTAR FASCIITIS, A PROSPECTIVE CONTROLLED RANDOMIZED CLINICAL STUDY

Introduction:- Plantar fasciitis is the most common cause of heel pain. It is a self-limiting condition. If causative factors are not addressed properly, it becomes chronic plantar fasciitis. Objectives:- The study aimed to evaluate the efficacy of 15 % hypertonic dextrose (treatment group) in the treatment of chronic plantar fasciitis through comparison with a cocktail group (control group). Design:- In this prospective controlled, randomized clinical study at N.S.C.B. Medical College Jabalpur, from 1 January 2020 to 31 September 2021. The statistical test used in this study isthe chi-square test and independent students t-test.A totalof 41 patients were taken intothe study. Patients were divided into two groups, In the Prolotherapy group (treating group) (n=18), a single shot of 15% Hypertonic dextrose injection was administered (1.2 ml of 50 % hypertonic dextrose, 1.8 ml distilled water and 1 ml of 2% lignocaine mixture)and the cocktail group (control group) (n=23) single shot of cocktail was given (1ml 40mg local methylprednisolone mixed with 1 ml distilled water and with 1 ml 2% lignocaine). During a 24-week follow-up period, pain intensity was measured using the visual analoguescale and American orthopaedics foot and ankle score, the measurements were undertaken before treatment and post-treatment weeks 4 and 12 and 24. Result:- In this study, both treatments were significantly effective in plantar fasciitis treatment for up to the 12th week. However the cocktail group (control group) was found to have a significantly better result at both the 4th week (AOFAS 93.17±3.33, VAS 1.65±.49 vs AOFAS 71.94±5.46, VAS 4.54±.71) and 12th week (AOFAS 90.43±2.86, VAS 1.91±.29 vs AOFAS 76.78±4.12, VAS 3.94±.64), but significantly better even up to 24th weeks (AOFAS 86.39±4.20, VAS 2.35±.71vs AOFAS 67.22±4.19, VAS 5.00±.34), (p-value &lt;.001) in term of pain intensity and disability as compared to prolotherapy group (treating group). Conclusion:- This study showed a favourable outcome towards the cocktail injectionin terms of VAS and AOFAS score as compared to prolotherapy injection.

A critical analysis of labeling errors of high-alert medications – Safety assessment and remedial measures through case based approach

Background and objectiveWrong labeling of the drugs is one of the critical issues that can end up in serious health issues among patients. Labeling errors of high-risk medications can lead to permanent disability or death of patients in critical settings. This article aims in identifying and analyzing the critical labeling error of the parenteral products and draws a comprehensive outline of its remediations and unintended consequences with respect to patient safety. Materials and methodsThe pharmaceutical supply chain department of high-end Tertiary hospitals and community pharmacies located in Udupi and Dakshina Kannada districts in Karnataka, India were visually inspected using a validated checklist for labeling errors in parenteral products. Defective products with labeling errors were identified and procured. ResultsTwo defective samples with labeling errors were identified. A small volume parenteral (infusion) bottle having both 50% Dextrose and Atropine sulphate injection (100 mg) mentioned on the same label and a Biphasic Isophane Insulin Injection (a × b mL) cartridge with missing batch code was procured from the Hospital Pharmacies. ConclusionStreamlining the process of labeling errors, development of strategies, providing effective training to manufacturing personnel, dispensing pharmacists and all other healthcare professionals and improving regulatory compliance by adhering to current Good Manufacturing Practices can contribute to the reduction of labeling errors. This study will create sound awareness among the healthcare care professionals, pharmaceutical manufacturers, and stakeholders/policy makers by the in-depth exploration of real-life problems and help them in the initiation of necessary measures to avoid such problems in future.

Six Treatments Have Positive Effects at 3 Months for People With Patellofemoral Pain: A Systematic Review With Meta-analysis.

OBJECTIVE: To determine the effects of nonsurgical treatments on pain and function in people with patellofemoral pain (PFP). DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched MEDLINE, Web of Science, and Scopus databases from their inception until May 2022 for interventional randomized controlled trials (RCTs) in people with PFP. STUDY SELECTION CRITERIA: We included RCTs that were scored ≥7 on the PEDro scale. DATA SYNTHESIS: We extracted homogenous pain and function data at short- (≤3 months), medium- (>3 to ≤12 months) and long-term (>12 months) follow-up. Interventions demonstrated primary efficacy if outcomes were superior to sham, placebo, or wait-and-see control. Interventions demonstrated secondary efficacy if outcomes were superior to an intervention with primary efficacy. RESULTS: We included 65 RCTs. Four interventions demonstrated short-term primary efficacy: knee-targeted exercise therapy for pain (standardized mean difference [SMD], 1.16; 95% CI: 0.66, 1.66) and function (SMD, 1.19; 95% CI: 0.51, 1.88), combined interventions for pain (SMD, 0.79; 95% CI: 0.26, 1.29) and function (SMD, 0.98; 95% CI: 0.47, 1.49), foot orthoses for global rating of change (OR = 4.31; 95% CI: 1.48, 12.56), and lower-quadrant manual therapy for function (SMD, 2.30; 95% CI: 1.60, 3.00). Two interventions demonstrated short-term secondary efficacy compared to knee-targeted exercise therapy: hip-and-knee-targeted exercise therapy for pain (SMD, 1.02; 95% CI: 0.58, 1.46) and function (SMD, 1.03; 95% CI: 0.61, 1.45), and knee-targeted exercise therapy and perineural dextrose injection for pain (SMD, 1.34; 95% CI: 0.72, 1.95) and function (SMD, 1.21; 95% CI: 0.60, 1.82). CONCLUSIONS: Six interventions had positive effects at 3 months for people with PFP, with no intervention adequately tested beyond this time point. J Orthop Sports Phys Ther 2022;52(11):750-768. Epub: 8 September 2022. doi:10.2519/jospt.2022.11359.

Efficacy of dextrose prolotherapy for the management of chronic temporomandibular disorders

Background and objective: Temporomandibular disorders defined as multiple orofacial conditions that cause pain at temporomandibular joint or associated muscles or both of them, limitation of mouth opening, problem of lateral movement of the jaw and functional joint sounds. Temporomandibular disorders can be treated with non invasive or invasive therapy according to the indication of each condition, non invasive therapy involve medication, physiotherapy, oral splints, injection therapy while invasive therapy include arthrocentesis, arthroscope or surgery. The present study designated to find out the effect of dextrose prolotherapy as a hypertonic material for treating common chronic temporomandibular disorders. Methods: 40 patients were divided into two groups randomly, prolotherapy group received dextrose injection, while medication group received myogesic and profen tab. The variables recorded are pain of the joint, masseter muscle, degree of mouth opening, clicking and hypermobility, follow up period was 1 week, 1 month, and 2 months. Results: The mean of joint pain score and masseter muscle pain score of the medication group were higher than those of the prolotherapy group, but the differences were not significant (p = 0.253, and p = 0.102 respectively).

COMPARISON OF HYDRODISSECTION INJECTION THERAPY USING ULTRASONOGRAPHIC AS GUIDES BETWEEN TRIAMCINOLONE ACETONIDE AND 5% DEXTROSE IN CARPAL TUNNEL SYNDROME

Background: Carpal Tunnel Syndrome (CTS) is a symptomatic compression neuropathy of the median nerve characterized by increased pressure in the carpal tunnel and decreased nerve function due to compression of the median nerve in the carpal tunnel. The purpose of the hydrodissection injection method in CTS is to separate the soft tissue adhesions that cause nerve compression and this method are known for being minimally invasive, fast healing, and easy to apply. Local injection of triamcinolone acetonide (TCA) is often used as therapy for CTS because it stabilizes the sodium channels and reduces abnormal stimulatio, thus it relieved the pain. 5% dextrose injection (D5W) is also widely used as therapy of CTS because it is harmless to nerves and may reduce neurogenic inflammation through inhibition of capsaicin-sensitive receptors. Aim: To compare the effectivity of hydrodissection injection therapy using ultrasound guidance with triamcinolone acetonide and 5% dextrose in CTS. Methods: This study recruited 30 participants who diagnosed with CTS and met the inclusion criteria. Participants were divided into two treatment groups, the first group (n=15) was given 1ml TCA injection and 1 ml lidocaine 2%, while the second group (n=15) was given 5% 5 ml Dextrose injection. The parameters measured in this study were NRS, FSS, and SSS value before injection and 4 weeks after injection of the agent. We compared these parameters at week four after injection between the TCA group and the D5W group. Results: NRS values before and 4 weeks after TCA injection (sig 0.001; p &lt;0.05), FSS values (sig 0.020; p &lt;0.05), and SSS values (sig 0.001; p &lt;0.05). NRS before and 4 weeks after injection of D5W (sig 0.002; p &lt;0.05), FSS (sig 0.001; p &lt;0.05), and SSS (sig 0.000; p &lt;0.05). Comparison between TCA injection and D5W injection at 4 weeks after the injection showed that the results was significantly different on NRS (sig 0.806; p&gt; 0.05) for FSS (sig 0.512; p&gt; 0.05) and SSS (sig 0.293; p&gt; 0.05). Conclusion: There is a significant difference in NRS, FSS and SSS values at 4 weeks after hydrodissection injection, using either TCA or D5W. TCA hydrodissection injection compared to D5W hydrodissection injection was equally effective in improving NRS, FSS and SSS after 4 weeks of injection.

Perineural 5% Dextrose Injection Treatment and Central Core Excision of the 12:00 Vestibule as Adjunctive Therapies to Complete Vestibulectomy in Select Patients with Neuroproliferative Vestibulodynia

ABSTRACT Introduction Complete vestibulectomy with vaginal advancement flap (CVVAF) for the treatment of neuroproliferative vestibulodynia (NPV) involves excision of the 1:00 to 11:00 region surrounding the urethral meatus and introitus, allowing the vagina and urethral meatus to be anastomosed to the vulva. The vestibule, however, extends above the urethral meatus and below the clitoris (12:00 region). In NPV patients, the entire vestibule including the 12:00 region contains excess mast cells/nerves, however the 12:00 region is not usually addressed during CVVAF surgery. While CVVAF surgery is associated with an approximately 80% success rate, we have observed some patients with significant pain at the 12:00 region pre-operatively who continue to have persistent entrance dyspareunia post-operatively. Objective We report on novel medical/surgical adjunctive strategies for NPV patients with pre-operative 12:00 pain implemented to reduce post-operative pain: using perineural 5% dextrose injection treatments pre-operatively; and performing a limited central core excision of the 12:00 vestibule during CVVAF. Perineural 5% dextrose injections have been shown to reduce neuropathic pain, in part by blocking the transient receptor potential vanilloid - TRPV-1 receptor. Methods In patients scheduled for CVVAF to treat suspected NPV, we performed preoperative vulvoscopy and baseline cotton-tip swab testing at the 12:00 region. In those with significant pain/tenderness at 12:00 (&amp;gt; 4/10 pain), we offered pre-operative perineural 5% dextrose treatments for the three days prior to CVVAF. Each day, cotton-tip swab testing of the 12:00 region was repeated prior to application of local anesthesia with 20% benzocaine, 8% lidocaine, 6% tetracaine. After anesthesia was established, betadine was applied to the region. Insulin syringes (31-gauge needle, 5/16”, 1 ml) filled with 5% dextrose were administered at six locations (total 6 ml) circling the 12:00 region, and compression applied for three minutes. The day after the final treatment, the patient underwent CVVAF including central core excision of the 12:00 region. All vestibular specimens were sent for immunohistochemical staining. Results 14 women, mean age 29 ± 9 years, had 12:00 pain &amp;gt; 4/10 on cotton swab testing at baseline, and confirmed immunohistochemical findings of excess mast cells/nerves consistent with NPV in all specimens. Baseline cotton-tip swab testing mean pain score prior to treatment was 7.3/10 (range 5-10/10) involving the entire 12:00 region. After three perineural 5% dextrose injection treatments, the cotton-tip swab testing mean pain score was reduced to 2.8/10 (range 0-5/10), focused on the central core region of the 12:00 vestibule. Side effects of perineural 5% dextrose injection were limited to mild bruising at injection sites in all patients. The central core excised specimens included the 12:00 minor vestibular gland ostia, and was oval-shaped, on average 2 mm thick, 6 mm wide and 7 mm long. Interrupted vertical sutures of 3-0 vicryl allowed for a horizontal closure of the defect. In patients who returned for in-person post-operative vulvoscopy at 6 months, the post-op cotton-tip swab testing mean pain score was 2.3/10 (range 0-4/10). Conclusions While more research is needed, preliminary results with these adjunctive therapies in selective NPV patients are encouraging. Disclosure No

Clitoral Dysesthesia Following Suprapubic Liposuction: A Case Report of Injury to the Nerves Adjacent to the Clitoris

ABSTRACT Introduction Clitorodynia is a bothersome genito-pelvic dysesthesia characterized by atypical sensations such as burning, stinging, and/or sharp pain confined to the glans clitoris, common clitoral shaft and/or prepucial (hood) area that may be constant, intermittent or occurring only when provoked. Clitorodynia, like other genito-pelvic dysesthesia conditions, may result from a trigger in the end organ (clitoris), pelvic/perineum (pudendal/pelvic nerve neuropathy), cauda equina (Tarlov cyst, annular tear), spine, or brain. While the primary sensory nerve of the clitoris is the dorsal nerve, there are sensory nerves adjacent to the clitoris in the suprapubic area. A 55 year old woman who presented to our sexual medicine clinic for evaluation of clitoral dysesthesia following a suprapubic liposuction in May 2016. She described a 5 year history of unusual, unwanted, unrelenting sensations that felt weird, electrical, uncomfortable, and "nervy", were located to the left side of her clitoris/upper left inner labia, were present all the time at a minimum 5/10 intensity increasing to 7-8/10 that prevented her from focusing on tasks, including sexual activity. Objective We herein describe our evaluation and management of this patient with clitoral genito-pelvic dysesthesia. Methods The evaluation involved a detailed biopsychosocial assessment including: medical history; psychologic assessment; hormone assessment; vulvoscopy with cotton-tip swap testing; neurogenital testing for assessment of the integrity of the pudendal and sciatic nerves; and left clitoral/left inner labia anesthesia testing to assess for clinically significant symptom reduction. Results History was positive for diabetes mellitus, hypercholesterolemia, hypertension, abdominoplasty surgery (2007) and L5-S1 fusion (2010). Physical examination using vulvoscopy with cotton-tip swab testing revealed a focal region of dysesthesia (∼ 4 cm long, ∼2 cm wide) to the left of the clitoris and left upper inner labia associated with significant tenderness (7/10). Pudendal nerve integrity testing was normal. Sciatic nerve integrity testing was abnormal consistent with her previous spine surgery. Cotton-tip swab testing after focal anesthesia of the region of dysesthesia with benzocaine 20%, lidocaine 8% and tetracaine 6% revealed a clinically significant symptom reduction to pain free (0/10). Conclusions Clitoral dysesthesia can occur from injury to the nerves adjacent to the clitoris. This is a case of clitoral genito-pelvic dysesthesia in the end organ following a liposuction procedure to the suprapubic area. The most likely trigger was iatrogenic neuropathic injury of the left anterior labial branch of the genital branch of the genitofemoral nerve and/or left anterior labial branch of the ilioinguinal nerve. These latter nerves course in the suprapubic area and do not innervate the clitoris itself. Nerve testing of the clitoris, innervated by the dorsal nerve branch of the pudendal nerve, was unremarkable. Proposed management of the clitoral dysesthesia will focus on treating the iatrogenic peripheral neuropathy in the end organ and include perineural 5% dextrose injections, low intensity shockwave treatments, platelet rich plasma injections, and/or steroid injections. Disclosure No

Intradermal Glucose 5% Injections for Mild Localized Neuropathic Pain - A New Approach to Reduce Pain Medication

As localized neuropathic pain can seriously decrease quality of life, physicians are challenged to look for treatment modalities which are easy to apply, safe and effective. Over the last decade, isotonic glucose (or dextrose) injections have received more attention among clinicians worldwide. In this article, the focus is on the application of intradermal injections of glucose 5%. Glucopuncture is especially interesting for doctors and patients who live in remote areas where pain medications are not available, or too expensive.

Glucopuncture for Rotator Cuff Related Shoulder Pain: an Alternative for Cortisone?

As rotator cuff related shoulder pain is quite prevalent, it is important that doctors continue to look for new treatment modalities, which are safe and effective. Over the last decade, isotonic glucose (or dextrose) injections have received more attention among clinicians. Unfortunately, no large randomized clinical trials have confirmed their effectiveness so far. However, their safety profile is very likely to be much better than subacromial corticosteroid injections. This article invites the medical community for further basic-science and clinical studies to investigate the potential benefits of local isotonic glucose injections for rotator cuff related shoulder pain. The goal of introducing the term Glucopuncture is to explain the difference with prolotherapy, to inform doctors about the interesting riskbenefits ratio of these regional isotonic glucose injections and to invite them to use these sugar water injections instead of cortisone injections.