Dextrose as an effective agent in the treatment of entrapment neuropathies by Hydrodissection

Abstract

Background. Entrapment neuropathies are a diverse group of peripheral nerve disorders caused by the compression and irritation of nerves at structurally narrow areas. More recently, interest has grown in the novel minimally invasive ultrasound-guided method in the treatment of entrapment neuropathies: nerve hydrodissection. This emerging procedure involves the injection of various substances around the nerve to separate it from surrounding tissues in order to allow for decompression and healing.  Among injectable agents, 5% dextrose in water (DW) has gathered much interest because of its favorable properties. Aim. The objective of this study was to describe potential mechanisms of action, efficacy and safety of 5% dextrose in water in the management of entrapment neuropathies via hydrodissection based on recently published studies. Materials and methods. This study is a narrative review.  Articles related to nerve hydrodissection with 5% dextrose in water published from 2020 (past 5 years) were included. Results. Hydrodissection by 5% dextrose in water significantly improves both symptoms and functions in various neuropathies. The application of 5% dextrose and water solution appears to have been explored extensively as a treatment for carpal tunnel syndrome. Compared to other treatments, including corticosteroids and local anesthetics, this solution shows a more sustained response and a good safety profile, with no adverse reactions reported. However, the true mechanism of action of 5% dextrose and water remains unclear. Proposed mechanisms include modulation of TRPV1 receptors, thereby playing a role in the attenuation of neuropathic pain. Conclusions. Hydrodissection using 5% dextrose and water solution can be considered an effective modality of therapy for entrapment neuropathies, with its efficacy best proved in the treatment of carpal tunnel syndrome.