Topical Anaesthesia to Reduce Pain Associated with Carpal Tunnel Surgery

2002 ◽  
Vol 27 (5) ◽  
pp. 462-464 ◽  
Author(s):  
T. M. LAWRENCE ◽  
V. V. DESAI
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Eutectic Mixture ◽  
Local Anaesthetics ◽  
Needle Insertion ◽  
Visual Analogue Pain ◽  
Pain Scores ◽  
Carpal Tunnel Surgery

This randomized, double-blinded study assessed the effectiveness of a topical anaesthetic, eutectic mixture of local anaesthetics (EMLA), in reducing pain associated with carpal tunnel release performed under local anaesthetic. Fifty-six patients undergoing carpal tunnel release under local anaesthetic were randomized into either EMLA ( n=29) or placebo ( n=27) groups. Visual analogue pain scores were obtained for needle insertion, injection of anaesthetic and surgery itself. Pain scores were significantly less for needle insertion ( P=0.001) and injection of anaesthetic ( P=0.0005). Scores related to surgery were also lower in the EMLA group, but this did not reach statistical significance.

SHORT VERSUS LONG-ACTING LOCAL ANAESTHETIC IN OPEN CARPAL TUNNEL RELEASE: WHICH PROVIDES BETTER PREEMPTIVE ANALGESIA IN THE FIRST 24 HOURS?

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 45-47 ◽  
Author(s):  
Z. H. Chan ◽  
V. Balakrishnan ◽  
A. McDonald
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Carpal Tunnel Release ◽  
Local Anaesthetics ◽  
Pain Scores ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Long Acting ◽  
Open Carpal Tunnel Release

Open carpal tunnel release is commonly performed under local anaesthesia. No study has compared intra-operative short- versus long-acting local anaesthetics as preemptive analgesics in carpal tunnel surgery. In this single-blinded prospective study, 100 consecutive carpal tunnel releases were performed by a single surgeon at one institution with either lignocaine (n = 50) or ropivacaine (n = 50). Allocation was performed via the method of alternation. Subjects were given a questionnaire to answer the following: (1) time to first incidence of pain, (2) quality of first night's sleep, and (3) mean numerical pain scores in the first 24 hours. The time to the first postoperative pain was significantly shorter in the lignocaine group (5.58 vs. 9.17 hours, p < 0.035). There were no significant difference in the incidence of poor first night's sleep (16% vs. 26%, p = 0.28) or mean pain scores in the first day (3.6 vs. 2.9, p = 0.16). Existing evidence advocates for long-acting intraoperative local anaesthetic because it results in a longer duration of postoperative analgesia, however, our study suggests that it may also result in a poorer first night's sleep.

Warm or refrigerated local anaesthetic for open carpal tunnel release: a single blind randomized controlled study

2009 ◽  
Vol 35 (3) ◽  
pp. 232-233 ◽  
Author(s):  
P. J. Tomlinson ◽  
J. Field
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Room Temperature ◽  
Carpal Tunnel Release ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Open Carpal Tunnel Release ◽  
Patients Experience

The aim of this randomized controlled study was to determine whether administration of lignocaine with adrenaline is less painful when injected at room temperature compared to refrigerated temperature. A cohort of 50 patients undergoing unilateral carpal tunnel decompression was randomized to room temperature or refrigerated local anaesthetic. Pain scores were assessed using a 10 mm visual analogue scale. Mean pain scores were 4.0 (SD ± 1.5) for room temperature and 6.5 (SD ± 1.7) for refrigerated local anaesthetic ( P < 0.001). This study demonstrates that patients experience greater pain levels with administration of local anaesthetic at refrigerated temperatures prior to open carpal tunnel release.

Arm sling after carpal tunnel surgery: myth or evidence based?

2019 ◽  
Vol 45 (3) ◽  
pp. 255-259
Author(s):  
Maartje Kroeze ◽  
Hinne Rakhorst ◽  
Peter Houpt
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Symptom Relief ◽  
Hand Surgery ◽  
Volumetric Analysis ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Carpal Tunnel Release Surgery

Arm sling elevation is widely used after hand surgery to prevent swelling and pain. This prospective cohort study investigated whether arm sling elevation has any value after carpal tunnel release surgery. Patients were assigned to one of two groups after carpal tunnel release: with or without arm sling elevation. The primary outcome was postoperative swelling. Secondary outcomes were pain and symptom relief and functional outcome. Volumetric analysis showed no significant difference between the sling and non-sling group. Pain scores and improvement of symptom severity and functional status scores were similar for both groups. Thirty-eight per cent found the sling uncomfortable. These results do not support routine use of arm sling elevation after carpal tunnel release. Level of evidence: III

scholarly journals Supraretinacular endoscopic carpal tunnel release: A safe alternative method for treatment of carpal tunnel syndrome

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199340
Author(s):  
Kotaro Sato ◽  
Kenya Murakami ◽  
Yoshikuni Mimata ◽  
Gaku Takahashi ◽  
Minoru Doita
Keyword(s):  
Learning Curve ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Open Surgery ◽  
Carpal Tunnel Release ◽  
Safe Alternative ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Carpal Tunnel Surgery ◽  
Conversion Rates

Purpose: Supraretinacular endoscopic carpal tunnel release (SRECTR) is a technique in which an endoscope is inserted superficial to the flexor retinaculum through a subcutaneous tunnel. The benefits of this method include a clear view for the surgeon and absence of median nerve compression. Surgeons can operate with a familiar view of the flexor retinaculum and median nerve downward, similar to open surgery. This study aimed to investigate the learning curve for SRECTR, an alternate method for carpal tunnel release, and evaluate its complications and the functional outcomes using a disposable commercial kit. Methods: We examined the open conversion rates and complications associated with SRECTR in 200 consecutive patients performed by two surgeons. We compared the operative time operated by a single surgeon. We evaluated outcomes in 191 patients according to Kelly’s grading system. Patients’ mean follow-up period was 12.7 months. Results: Nine patients required conversion to open surgery. There were no injuries to the nerves and tendons and no hematoma or incomplete dissection of the flexor retinaculum. The operative times varied between 11 and 34 minutes. We obtained the following results based on Kelly’s grading of outcomes: excellent in 116, good in 59, fair in 13, and poor in 3 patients. Conclusions: We found no patients with neurapraxia, major nerve injury, flexor tendon injury, superficial palmar arch injury, and hematoma. Although there was a learning curve associated with SRECTR, we performed 200 consecutive cases without neurovascular complications. This method may be a safe alternative to minimally invasive carpal tunnel surgery.

Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial

2018 ◽  
Vol 43 (8) ◽  
pp. 808-812 ◽  
Author(s):  
Hafiz J. Iqbal ◽  
Ashtin Doorgakant ◽  
Nader N. T. Rehmatullah ◽  
Ashok L. Ramavath ◽  
Prasad Pidikiti ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Controlled Trial ◽  
Carpal Tunnel Release ◽  
Similar Degree ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Anaesthetic Mixture

We conducted a prospective randomized controlled trial to investigate carpal tunnel decompression under local anaesthesia. Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an arm tourniquet and 36 without tourniquet but with a local anaesthetic mixture containing adrenaline. Patients who underwent carpal tunnel decompression using a tourniquet experienced a significantly greater degree of pain when compared with those who did not have a tourniquet. Pain and hand function improved to a similar degree in both groups. We conclude that carpal tunnel decompression performed with a tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a tourniquet. Level of evidence: I

scholarly journals Patient Comprehension of Carpal Tunnel Surgery

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Gregory R. Waryasz ◽  
Joseph A. Gil ◽  
Daniel Chiou ◽  
Paul Ramos ◽  
Jonathan R. Schiller ◽  
...  
Keyword(s):  
Health Literacy ◽  
Carpal Tunnel ◽  
Postoperative Care ◽  
Medical Condition ◽  
Carpal Tunnel Release ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Average Percentage ◽  
Patient Comprehension ◽  
Carpal Tunnel Surgery

Background: Health literacy is the ability of a patient to understand their medical condition. The purpose of this investigation is to determine whether patients are able to obtain an elementary understanding of the fundamental principles of carpal tunnel release and the postoperative instructions after going through the process of informed consent and being provided an additional standardized postoperative instruction document. Our hypothesis is that patients will lack an understanding of these principles and, therefore, will be at risk for being noncompliant in their postoperative care. Methods: Fifty patients with a diagnosis of carpal tunnel surgery who elected to undergo carpal tunnel release alone were enrolled. A standardized education process was performed. Patients completed the questionnaire at their postoperative visit. Results: The average percentage of correct answers was 75.8% (8.34 out of 11 correct). Fisher exact test analysis demonstrated that patients with a lower education level were less likely to know how long it takes for their preoperative symptoms to resolve ( P = .0071), and they were less likely to correctly choose all of the important elements of postoperative care during the first week after surgery ( P = .022). Conclusions: Although we made efforts to help patients achieve health literacy in carpal tunnel surgery, we found that patients continued to lack comprehension of pertinent components of carpal tunnel surgery, particularly understanding the involved anatomy.

Co-existing carpal tunnel syndrome in complex regional pain syndrome after hand trauma

2009 ◽  
Vol 35 (3) ◽  
pp. 228-231 ◽  
Author(s):  
S. M. Koh ◽  
F. Moate ◽  
D. Grinsell
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Range Of Motion ◽  
Grip Strength ◽  
Complex Regional Pain Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Pain Syndrome ◽  
Hand Surgery ◽  
Pain Scores ◽  
Tunnel Syndrome

This study highlights the benefits of carpal tunnel release (CTR) in four patients presenting with complex regional pain syndrome (CRPS) after hand surgery who also had carpal tunnel syndrome (CTS) diagnosed clinically and by nerve conduction studies. Three of the patients underwent pre- and postoperative volumetric, circumference, grip strength and range of motion measurements. The Disabilities of the Arm, Shoulder and Hand (DASH) functional outcome measure and pain scores were also used. There was almost complete resolution of CRPS symptoms in all four patients, with notable reductions in oedema and improvements in grip strength and range of motion. There were also improvements in DASH outcome scores and pain scores after CTR.

Variations in incisions and postoperative management in carpal tunnel surgery

2002 ◽  
Vol 10 (2) ◽  
pp. 63-67 ◽  
Author(s):  
Carolyn M Levis ◽  
Thomas H Tung ◽  
Susan E Mackinnon
Keyword(s):  
Carpal Tunnel ◽  
Postoperative Care ◽  
Carpal Tunnel Release ◽  
Vertical Axis ◽  
Postoperative Management ◽  
Anatomical Landmarks ◽  
The Third ◽  
Carpal Tunnel Surgery ◽  
Web Space ◽  
Open Carpal Tunnel Release

This study examines the variations in incisions and postoperative protocol of open carpal tunnel release. A questionnaire was distributed to 65 hand surgeons. Respondents were asked to draw their preferred incision on original photocopies of the same palm. The results were measured against standard anatomical landmarks (thenar crease, vertical axis of the third web space, proximal palmar crease and the distal wrist crease). The participants were also asked to answer questions concerning their postoperative protocols. Demographics of the cohort, as well as the variations in incisions and postoperative management, were analyzed. Significant variations existed in the length and location of the incision in the palm. The differences in postoperative care in this cohort of surgeons were less significant.

scholarly journals Decreased Rate of Complications in Carpal Tunnel Release with Hand Fellowship Training

2018 ◽  
Vol 10 (01) ◽  
pp. 026-028 ◽  
Author(s):  
Santosh Mathen ◽  
Naveed Nosrati ◽  
Gregory Merrell
Keyword(s):  
Nerve Injury ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Wound Dehiscence ◽  
Fellowship Training ◽  
Orthopedic Surgeons ◽  
Surgeon Training ◽  
Improved Outcomes ◽  
Tunnel Syndrome

Abstract Purpose In many procedures, both high case volumes and fellowship training have been shown to improve outcomes. One of the most common procedures performed by hand surgeons, the carpal tunnel release (CTR) is also performed by several other specialties without specialty training in a hand fellowship. This study analyzed the effect that hand fellowship training has on outcomes of CTRs. Materials and Methods Using the American Board of Orthopedic Surgeons (ABOS) Part II candidates’ case list submissions, a database was created for all open and endoscopic CTRs. Surgeon training, demographics, technique, and complications were recorded. Complications were then categorized and broken down by technique. Results were then analyzed for statistical significance. Results A total of 29,916 cases were identified. Hand fellowship–trained surgeons performed six times more CTRs at 31 cases per surgeon compared with five for non-hand fellowship–trained surgeons. They also improved outcomes in rates of infection, wound dehiscence, and overall complications. Rates of nerve injury or recurrence showed no statistical difference. This held true for the open release subset. Endoscopically, fellowship-trained surgeons had only improved rates of overall complications. Conclusion Surgeons undergoing additional hand fellowship training may show improved outcomes in the surgical treatment of carpal tunnel syndrome. However, no effect was seen on nerve injury or recurrence of symptoms.

scholarly journals Minimally Invasive Carpal Tunnel Release (CTR) Using the Wongsiri Technique with MiniSURE

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Sunton Wongsiri ◽  
Wongthawat Liawrungrueang
Keyword(s):  
Minimally Invasive ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Endoscopic Surgery ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Line Of Sight ◽  
Open Technique ◽  
Working Space ◽  
Carpal Tunnel Surgery

Introduction. The standard open technique for carpal tunnel surgery has wound problems and complications significantly more than minimally invasive surgery using the Wongsiri technique with MiniSURE Kit® (Surgical Innovation Healthcare Co., Ltd, Bangkok, Thailand) and in particular, the open technique surgery requires a longer time for return to work. CTR surgery with endoscopic devices improves the results with fewer wound problems when compared with the commonly used open technique; however, nerve complications and injury are more prevalent with endoscopic surgery than with the open technique. The Wongsiri technique produces good results with new medical devices such as the MiniSURE View, for improved vision and line-of-sight, and the MiniSURE Cut for improved and complete cutting via the supraretinacular technique that may reduce the nerve problems associated with endoscopic tooling in the carpal tunnel. Purpose. To evaluate the results of the operation and postoperative outcomes of the Wongsiri technique with a MiniSURE Kit®. Methods. 20 patients underwent carpal tunnel release using the Wongsiri technique and a MiniSURE Kit® with a five-step surgery: MIS starts when the surgeon makes a 1.5–1.8 cm incision, creates a working space, inserts the visual tube of MiniSURE View, inserts the freer, and then cuts the transverse carpal ligament by using the MiniSURE Cut. Results. All 20 successes of the Wongsiri technique and MiniSURE Kit® surgery occurred within 6.8 minutes operative time and a 12 mm wound size. A single outlier, in one case (6.7%), the patient experienced pillar pain which abated within one month. Patients can return to work in 7.3 days. Conclusions. The Wongsiri technique with the MiniSURE Kit® demonstrated good outcomes similar to the endoscope. By contrast with the endoscopic surgery, the Wongsiri technique with the MiniSURE Kit® reduced preop, operating, and postop time, many resources, and significant costs and resulted in no nerve problems or complications.

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