After the 2017 AMSSM meeting I have become more interested in prolotherapy to add to my current steroid, prp, hyalgan injections. Studies are a little vague on the exact mixture:
Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial . I would like to avoid lidocaine/marcaine if possible. any specific solution you are having success with? Please feel free to PM me thanks.
Wow, who presented on prolotherapy or how did they present it in the context of these other types of injection treatments? (steroids to prp, stem cell, etc.)
Standard that is being taught at the most established course/conference run by the Hemwall-Hackett-Peterson Foundation (David Rabago at U of Wisconsin heads this and has been the main proponent for research for prolotherapy) is 25% dextrose for intraarticular injections and 15% for extraarticular structures. I saw the report in the past year about local anesthetics and chondrotoxicity although that is not a new concept and not sure if anyone is going to stop adding local anesthetic in their knee steroid injections. At what rate is it chondrotoxic?
It may be considered worth the risk/benefit to keep including local anesthetic in prolotherapy injections. Keep in mind that there are only a finite number of treatments as you are trying to help address their condition rather than masking symptoms repeatedly a few times a year, thus their exposure to local anesthetic within the knee joint may be limited. Additionally, I believe the studies for knee OA used both intraarticular as well as extraarticular treatments, so much of the work to try and promote improved integrity of supportive structures within the knee will not be adding more local anesthetic to cartilage within the joint itself.
15% dextrose = 3cc 50% dextrose, 3cc NS, 4cc 1% lidocaine.
20% dextrose = 5cc 50% dextrose, 5cc 1% lidocaine
Personally, I think from a point of view of acceptance and standardization based on research studies, it's best to stick to something like this unless you are going to consider adding other sorts of proliferants to the treatments which I can't comment on.
Here's a review of prolotherapy in PM&R North America clinics journal from 2016.
http://www.pmr.theclinics.com/article/S1047-9651(16)30042-0/pdf
Happy to discuss offline further.