Comparison of the Short-Term Clinical Effectiveness of 5% Dextrose Water, Platelet-rich Plasma and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Abstract

Objective: To compare the short-term effectiveness of corticosteroids, 5% dextrose (D5W), and platelet-rich plasma (PRP) injections for treating carpal tunnel syndrome (CTS).

Data sources: Four databases (MEDLINE [PubMed], Embase, the Cochrane Controlled Trials Register, and Web of Science [WOS]) were researched from inception to the first of April 2022.

Study selection: Two authors independently screened the literature to identify the RCTs meeting the included criteria, which involved comparing corticosteroid, 5% dextrose water (D5W), and PRP injection with each other or placebo-controlled for treating CTS.

Data extraction: The 2 reviewers independently conducted information extraction, the utcomes included were the changes in Symptom Severity Scale, Functional Status Scale, and Visual Analog Scale at short-term follow-up after drug injection treatment and any adverse events reported.

Data synthesis: Twelve randomized controlled trials with 749 patients (817 hands) were included. The results of this study suggested that PRP injection was the most likely to relieve symptoms, improve functions, and alleviate pain, with the surface under the cumulative ranking curve being 91.5%, 92.7%, and 80.8%, respectively, after D5W injection (74.4%, 72.2%, 72.1%), and corticosteroid injection (33.7%, 31.9%, 46.2%). The injection of 3 drugs was significantly better than that of a placebo.

Conclusions: From the results of the network meta-analysis, PRP injection is the most recommended treatment among the injection of corticosteroid, D5W, and PRP.

Keywords: 5% dextrose; Carpal tunnel syndrome; Corticosteroid, therapy; Median nerve; Peripheral nerve entrapment; Platelet-rich plasma; Rehabilitation.