Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation

Background Carpal tunnel release (CTR) is the most common surgery of the hand, and interest is growing in performing it under local anesthesia without tourniquet. To better understand differences, we hypothesized that patients undergoing CTR under wide-awake local anesthesia with no tourniquet (WALANT) versus sedation (monitored anesthesia care [MAC]) would not result in a difference in outcome. Methods Consecutive cases of electrodiagnostically confirmed open CTR across multiple surgeons at a single center were prospectively enrolled. Data included demographic data, visual analog scale, Levine-Katz carpal tunnel syndrome scale, QuickDASH questionnaire, customized Likert questionnaire, and complications. Results There were 81 patients enrolled in the WALANT group and 149 patients in the MAC group. There were no reoperations in either group or any epinephrine-related complications in the WALANT group. Disability and symptom scores did not differ significantly between WALANT and sedation groups at 2 weeks or 3 months. Average postoperative QuickDASH, Levine-Katz, and VAS pain scales were the same in both groups. Both groups of patients reported high levels of satisfaction at 91 versus 96% for the WALANT versus MAC groups, respectively (p > 0.05). Patients in each group were likely to request similar anesthesia if they were to undergo surgery again. Conclusion Patients undergoing open CTR experienced similar levels of satisfaction and outcomes with either the WALANT or MAC techniques. There was no statistically significant difference between either group relative to the tested outcome measures. These data should facilitate surgeons and patients' choosing freely between WALANT and MAC techniques relative to complications and outcomes.

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Tourniquet Use in Wide-Awake Carpal Tunnel Release

Hand ◽

10.1177/1558944718787853 ◽

2018 ◽

Vol 15 (1) ◽

pp. 59-63 ◽

Cited By ~ 5

Author(s):

Sarah E. Sasor ◽

Julia A. Cook ◽

Stephen P. Duquette ◽

Elizabeth A. Lucich ◽

Adam C. Cohen ◽

...

Keyword(s):

Blood Loss ◽

Carpal Tunnel ◽

Local Anesthetic ◽

Operative Time ◽

Carpal Tunnel Release ◽

Estimated Blood Loss ◽

Tunnel Syndrome ◽

Clinically Significant ◽

Without Tourniquet ◽

Wide Awake

Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.

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Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1709087 ◽

2020 ◽

Author(s):

Nikolaos Karamanis ◽

Georgia Stamatiou ◽

Dionysia Vasdeki ◽

Nikolaos Sakellaridis ◽

Konstantinos C. Xarchas ◽

...

Keyword(s):

Grip Strength ◽

Local Anesthesia ◽

Carpal Tunnel ◽

Local Anesthetic ◽

Local Anesthetics ◽

Carpal Tunnel Release ◽

Postoperative Outcome ◽

Anesthetic Concentration ◽

Open Carpal Tunnel Release ◽

Wide Awake

Abstract Introduction Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.

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Neurophysiological Recovery After Open Carpal Tunnel Decompression: Comparison of Simple Decompression and Decompression with Epineurotomy

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(03)00152-9 ◽

2003 ◽

Vol 28 (5) ◽

pp. 450-454 ◽

Cited By ~ 33

Author(s):

N. BORISCH ◽

P. HAUSSMANN

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Carpal Tunnel Release ◽

Nerve Conduction Studies ◽

Motor Latency ◽

Significant Difference ◽

Tunnel Syndrome ◽

Open Carpal Tunnel Release ◽

Simple Decompression

Two hundred and seventy-three patients with carpal tunnel syndrome without advanced neurophysiological changes (distal motor latency below 11 ms) were randomized to treatment by open carpal tunnel release with, or without, epineurotomy. Patients were examined clinically and by nerve conduction studies preoperatively and at 3, 6 and 12 months postoperatively. We found no statistically significant difference between simple decompression and decompression combined with epineurotomy with regard to either the clinical or the neurophysiological outcome.

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The impact of tourniquet on patient satisfaction in carpal tunnel decompression

Open Medicine ◽

10.2478/s11536-007-0016-4 ◽

2007 ◽

Vol 2 (2) ◽

pp. 222-226 ◽

Cited By ~ 2

Author(s):

Kamal Nagpal ◽

Mohammed Gossiel ◽

Hari Kumar

Keyword(s):

Patient Satisfaction ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Clinical History ◽

Apparent Difference ◽

Significant Difference ◽

Tunnel Syndrome ◽

Without Tourniquet ◽

Time Of Operation ◽

The Impact

AbstractRelease of the transverse carpal ligament can be performed safely under local anesthesia and without the use of tourniquet. There are conflicting reports for the use of tourniquet in carpal tunnel syndrome. The aim of the study was to compare the patient satisfaction with and without tourniquet in patients with carpal tunnel decompression. This was a retrospective study performed in twenty-four patients who underwent bilateral carpal tunnel decompression. All the patients were diagnosed using a combination of clinical history, clinical tests and EMG recordings.One side was operated with use of tourniquet and other side without. Patient evaluation measure was used to assess the satisfaction score. A telephonic interview was conducted and patients were asked the questions regarding discomfort caused by tourniquet. The results demonstrated that there was a significant difference in discomfort at the tourniquet site at the time of operation (p<0.00017). Long term, there was no apparent difference in functional outcome of patients operated on with or without tourniquet. There was also no significant difference in subjective sensation, grip or use of hand in patients who underwent carpal tunnel release with or without tourniquet. We conclude that we should not use tourniquet in carpal tunnel decompression.

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WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Hand ◽

10.1177/15589447211003180 ◽

2021 ◽

pp. 155894472110031

Author(s):

Ian Wellington ◽

Antonio Cusano ◽

Joel V. Ferreira ◽

Anthony Parrino

Keyword(s):

Local Anesthesia ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Postanesthesia Care Unit ◽

Complication Rates ◽

Endoscopic Carpal Tunnel Release ◽

Average Operating ◽

Wide Awake ◽

No Tourniquet ◽

Room Time

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

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Endoscopic Carpal Tunnel Release

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0098 ◽

2019 ◽

pp. 989-994

Author(s):

Antony Hazel ◽

Neil F. Jones

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Surgery ◽

Anatomical Landmarks ◽

Transverse Carpal Ligament ◽

Palmar Arch ◽

Endoscopic Carpal Tunnel Release ◽

Tunnel Syndrome ◽

Carpal Tunnel Release Surgery ◽

Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

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Comparison of Local-Only Anesthesia Versus Sedation in Patients Undergoing Staged Bilateral Carpal Tunnel Release: A Randomized Trial

Hand ◽

10.1177/1558944719836237 ◽

2019 ◽

Vol 15 (6) ◽

pp. 785-792 ◽

Cited By ~ 1

Author(s):

Garrhett G. Via ◽

Andrew R. Esterle ◽

Hisham M. Awan ◽

Sonu A. Jain ◽

Kanu S. Goyal

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Common Disease ◽

Hand Laterality ◽

Included Patient ◽

High Satisfaction ◽

Tunnel Syndrome ◽

Second Procedure ◽

Wide Awake

Purpose: Carpal tunnel syndrome is a common disease treated operatively. During the operation, the patient may be wide-awake or sedated. The current literature has only compared separate cohorts. We sought to compare patient experience with both local-only anesthesia and sedation. Methods: Staged bilateral carpal tunnel release utilizing open or endoscopic technique was scheduled and followed through to completion of per-protocol analysis in 31 patients. Patients chose initial hand laterality and were randomized regarding initial anesthesia method: local-only or sedation. Data collection via questionnaires began at consent and continued to 6 weeks postoperatively from second procedure. Primary outcome measures included patient satisfaction and patient anesthesia preference. Results: At final follow-up, 6 weeks postoperatively, high satisfaction (30 of 31 patients per method) was reported with both types of anesthesia. Among these patients, 17 (54%) preferred local-only anesthesia, 10 (34%) preferred sedation, 2 had no preference, and 2 opted out of response. Although anesthesia fees were approximately $390 lower with local-only anesthesia, total costs for carpal tunnel release were not significantly different with respect to the anesthesia cohorts. Total time in surgical facility was approximately 26 minutes quicker with local-only anesthesia, largely due to shorter time in the post-anesthesia care unit. Scaled comparison of worst postoperative pain following the 2 procedures revealed no difference between local-only anesthesia and sedation. Conclusions: Patients reported equal satisfaction scores with carpal tunnel release whether performed under local-only anesthesia or with sedation. In addition, local-only anesthesia was indicated as the preference of patients in 59% of cases.

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