A COMPARATIVE EFFICACY OF STEROID PLUS BUPIVACAINE, 5% DEXTROSE AND HYALURONIDASE FOR MEDIAN NERVE BLOCK IN CARPAL TUNNEL SYNDROME: A RANDOMIZED CONTROL TRAIL

Abstract

Background: Carpal Tunnel Syndrome (CTS) produces three main events including pain and numbness together with functional disability. Multiple physicians have studied individual treatment methods including steroid mixed with bupivacaine and 5% dextrose along with hyaluronidase to treat symptoms, however our study compared the effects of these 3 treatment methods.

Methods: This study involved 90 patients diagnosed with mild to moderate CTS who received three different types of therapy group assignments: Group A therapy included steroid + bupivacaine (30 patients); Group B therapy consisted of 5% dextrose for 30 patients; and 30 patients received Group C therapy of hyaluronidase. The study measured outcomes through Visual Analog Scale (VAS) for pain and Boston Carpal Tunnel Questionnaire (BCTQ) for functional assessment as well as nerve conduction studies (NCS) and median nerve cross-sectional area (CSA) on ultrasound. Analysis was conducted through SPSS version 27.0.

Results: Baseline characteristics were comparable in all groups (p>0.05). At 6 months, Group C (hyaluronidase) showed the greatest pain reduction (VAS: 1.5 ± 0.57), followed by Group B (1.8 ± 0.68) and Group A (3.3 ± 1.30); p<0.001. Functional improvement was highest in Group C (BCTQ-SSS: 1.53 ± 0.31, BCTQ-FSS: 1.20 ± 0.23) compared to Group B (SSS: 1.63 ± 0.49, FSS: 1.33 ± 0.27) and Group A (SSS: 2.86 ± 0.64, FSS: 2.34 ± 0.48); p<0.001. Nerve conduction velocity (NCV) improved most in Group C (43.3 ± 4.58 m/s) compared to Group B (39.8 ± 5.21 m/s) and Group A (33.9 ± 5.78 m/s); p<0.001. Median nerve CSA reduction was greatest in Group C (10.8 ± 1.95 mm²) vs. Group B (11.2 ± 1.89 mm²) and Group A (13.5 ± 2.01 mm²); p<0.001.

Conclusion: Chronic pain intensity along with functional capacity showed improvement in patients who received any of the three treatment modalities. The application of hyaluronidase produced the leading long-term advantages for pain reduction in combination with nerve function and structural repair. Steroid-bupivacaine created the quickest symptom relief and 5% dextrose provided ongoing but moderate symptom relief.