Combined Stellate Ganglion Block With Median Nerve Hydrodissection Versus Median Nerve Hydrodissection Only in Carpal Tunnel Syndrome

NCT07839611 | Not Yet Recruiting

• 1 other identifier: M892
• Study Type: interventional
• Target: 80
• Locations: 0 countries
• Sites: N/A

Brief Summary

the study aims to compare clinical and electrophysiological outcomes of combined stellate ganglion block plus median nerve hydrodissection versus hydrodissection alone in carpal tunnel syndrome, assessing pain, function, autonomic predictors, and safety over time.

Conditions

Carpal Tunnel Syndrome (CTS)

Keywords

stellate ganglion block; median nerve hydrodissection

Outcome Measures

Primary Outcomes (1)

• Change in Boston Carpal Tunnel Questionnaire Symptom Severity Scale Score from Baseline to 12 Weeks

  The Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) consists of 11 items, each scored from 1 to 5. The overall score is calculated as the mean of the 11 item scores, ranging from 1 to 5. Higher scores indicate greater symptom severity (worse outcome). The outcome is the change from baseline to the specified follow-up time point.

  baseline to 12 weeks

Secondary Outcomes (12)

• Change in Boston Carpal Tunnel Questionnaire Symptom Severity Scale Score from Baseline to 4 Weeks

  from baseline to 4 weeks

• Change in Boston Carpal Tunnel Questionnaire Symptom Severity Scale Score from Baseline to 8 Weeks

  from baseline to 8 weeks

• Change in Visual Analog Scale for Pain Score from Baseline to 4 Weeks

  from baseline to 4 weeks

• Change in Visual Analog Scale (VAS) for Pain Score from Baseline to 8weeks

  baseline to 8 weeks

• Change in Visual Analog Scale (VAS) for Pain Score from Baseline to 12 Weeks

  baseline to 12weeks

Study Arms (2)

combined stellate ganglion block with median nerve hydrodissection

EXPERIMENTAL

these patients will recieve combined ultrasound-guided stellate ganglion block (SGB) plus ultrasound-guided median nerve hydrodissection Stellate Ganglion Block Patient supine, neck slightly extended and turned away. Use ultrasound guidance at the C6 level. Identify the carotid artery, thyroid, longus colli muscle, and C6 transverse process. Insert the needle in-plane, avoiding vessels, toward the prevertebral fascia over the longus colli. After aspiration and confirmation of position, inject a small volume of local anesthetic. Observe for successful block, typically ipsilateral Horner syndrome (ptosis, miosis, facial anhidrosis Ultrasound-Guided Median Nerve Hydrodissection Position the patient with the forearm supinated Use a high-frequency linear ultrasound probe to identify the median nerve. Scan the nerve in short axis and identify surrounding vessels Inject a small amount of fluid to open the tissue plane around the nerve, then continue injection to achieve hydrodissection

Procedure: combined stellate ganglion block procedure and median nerve hydrodissection

median nerve hydrodissection only

ACTIVE COMPARATOR

these patients will recieve only ultrasound guided median nerve hydrodissection only as follow Ultrasound-Guided Median Nerve Hydrodissection Position the patient with the forearm supinated. Use a high-frequency linear ultrasound probe to identify the median nerve. Scan the nerve in short axis and identify surrounding vessels and tendons. Insert the needle in-plane, keeping the tip continuously visible. Advance the needle adjacent to the median nerve, without entering the nerve. Inject a small amount of fluid to open the tissue plane around the nerve, then continue injection to achieve circumferential hydrodissection. Confirm separation of the nerve from surrounding structures on ultrasound.

Procedure: Ultrasound-Guided Median Nerve Hydrodissection Procedure only

Interventions

combined stellate ganglion block procedure and median nerve hydrodissection PROCEDURE

Stellate Ganglion Block - Brief Technique Patient supine, neck slightly extended and turned away. Use ultrasound guidance at the C6 level. Identify the carotid artery, thyroid, longus colli muscle, and C6 transverse process. Insert the needle in-plane, avoiding vessels, toward the prevertebral fascia over the longus colli. After aspiration and confirmation of position, inject a small volume of local anesthetic. Observe for successful block, typically ipsilateral Horner syndrome (ptosis, miosis, facial anhidrosis). Monitor for complications such as vascular injection, hematoma, hoarseness, LAST, and airway compromise.

combined stellate ganglion block with median nerve hydrodissection

Ultrasound-Guided Median Nerve Hydrodissection Procedure only PROCEDURE

Ultrasound-Guided Median Nerve Hydrodissection - Brief Technique Position the patient with the forearm supinated. Use a high-frequency linear ultrasound probe to identify the median nerve. Scan the nerve in short axis and identify surrounding vessels and tendons. Insert the needle in-plane, keeping the tip continuously visible. Advance the needle adjacent to the median nerve, without entering the nerve. Inject a small amount of fluid to open the tissue plane around the nerve, then continue injection to achieve circumferential hydrodissection. Confirm separation of the nerve from surrounding structures on ultrasound. Monitor for pain, paresthesia, vascular puncture, or nerve injury. The total injected volume ranged from 5 to 10 mL for standard hydrodissection without steroid. Either normal saline or 5 percent dextrose in water was used,

median nerve hydrodissection only

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged 18 years or older.
• Patients diagnosed with carpal tunnel syndrome based on compatible clinical symptoms and signs.
• Diagnosis confirmed by nerve conduction studies/electrodiagnostic testing.
• Patients with mild to moderate carpal tunnel syndrome.
• Patients with persistent symptoms despite conservative treatment.
• Patients eligible for ultrasound-guided median nerve hydrodissection.
• Patients willing to participate in the study and provide written informed consent.

You may not qualify if:

• Previous surgical treatment for carpal tunnel syndrome in the affected hand.
• Severe carpal tunnel syndrome with marked thenar muscle wasting or severe axonal loss.
• Coexisting cervical radiculopathy or peripheral polyneuropathy.
• Previous fracture, major trauma, or surgery involving the affected wrist or hand.
• Other neurological or musculoskeletal conditions affecting the symptoms or functional assessment of the affected upper limb.
• Local infection, inflammation, or skin lesion at the injection site.
• Known bleeding disorder or contraindication to the injection procedure.
• Current anticoagulant therapy that contraindicates the procedure.
• Known allergy or contraindication to any medication used during the intervention.

Sponsors & Collaborators

• Fayoum University: lead

Related Publications (5)

• A Sousa LH, Costa CO, Novak EM, Giostri GS. Complex Regional Pain Syndrome after Carpal Tunnel Syndrome Surgery: A Systematic Review. Neurol India. 2022 Mar-Apr;70(2):491-503. doi: 10.4103/0028-3886.344616.

  PMID: 35532609 BACKGROUND

• Bland JDP. Hydrodissection for treatment of carpal tunnel syndrome. Muscle Nerve. 2018 Jan;57(1):4-5. doi: 10.1002/mus.25759. Epub 2017 Aug 21. No abstract available.

  PMID: 28786115 BACKGROUND

• Huang CY, Lai CY, Reeves KD, Lam KHS, Li TY, Cheng CI, Wu YT. Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome: A Prospective, Randomized, and Single-Blind Study. J Ultrasound Med. 2024 Jan;43(1):161-169. doi: 10.1002/jum.16349. Epub 2023 Oct 24.

  PMID: 37873682 BACKGROUND

• Lee K, Park JM, Yoon SY, Kim MS, Kim YW, Shin JI, Lee SC. Ultrasound-Guided Nerve Hydrodissection for the Management of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis. Yonsei Med J. 2025 Feb;66(2):111-120. doi: 10.3349/ymj.2024.0089.

  PMID: 39894044 BACKGROUND

• Pokharel S, Silwal S, Shrestha P, Neupane K. Ultrasound Guided Hydrodissection of Median Nerve with the Use of 5% Dextrose in Carpal Tunnel Syndrome: A Case Report. JNMA J Nepal Med Assoc. 2024 Sep;62(277):611-613. doi: 10.31729/jnma.8751. Epub 2024 Sep 30.

  PMID: 40655054 BACKGROUND

MeSH Terms

Conditions

Carpal Tunnel Syndrome

Condition Hierarchy (Ancestors)

Median Neuropathy; Mononeuropathies; Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Nerve Compression Syndromes; Cumulative Trauma Disorders; Sprains and Strains; Wounds and Injuries

Central Study Contacts

zeyad nabil researcher, master's reseacher

CONTACT

+20 01067112822; zeyadnabil555@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: the study will be assessor-blinded: The proceduralist cannot be blinded. Participants will be informed they will receive one of two active interventions; however, full participant blinding is not feasible without sham SGB. Outcome assessors (BCTQ, VAS, clinical tests), electrophysiology personnel (ENMG/NCS), and the statistician will be blinded to allocation. Group labels will be coded (Group 1/Group 2) until analysis is completed.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: resident,Department of anesthesia and surgical intensive care

Model Details: This study is a prospective, randomized, two-arm interventional clinical trial comparing combined ultrasound-guided stellate ganglion block (SGB) plus ultrasound-guided median nerve hydrodissection (Group A) versus ultrasound guided median nerve hydrodissection alone (Group B) in adults with mild-moderate carpal tunnel syndrome (CTS). The trial will be conducted at Fayoum University Hospital, Department of Pain Medicine and Anesthesia, after Institutional Review Board (IRB) approval. Written informed consent will be obtained from all participants prior to enrollment.

Study Record Dates

• First Submitted: August 26, 2026
• First Posted: September 24, 2026
• Study Start: September 1, 2026
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): September 1, 2027
• Last Updated: September 24, 2026

Record last verified: 2026-08