Anesthesia for Carpal Tunnel Surgery

2018 ◽  
pp. 369-378
Author(s):  
Curtis Choice
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Ambulatory Surgery ◽  
Carpal Tunnel Release ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Ambulatory Surgery Centers ◽  
Carpal Tunnel Surgery ◽  
Wide Awake

Carpal tunnel surgery to release the entrapped median nerve is a common outpatient procedure performed in ambulatory surgery centers. The more common, traditional technique is the open carpal tunnel release. The newer minimally invasive surgical technique is the endoscopic carpal tunnel release. The most common anesthetic technique is monitored anesthesia care consisting of intravenous sedation with local anesthetic infiltration by the surgeon. Intravenous local anesthesia, the Bier block, was previously offered as an alternative to general anesthesia. Wide awake local anesthesia no tourniquet surgery or wide awake hand surgery is an option growing in popularity. Finally, ultrasound-guided peripheral nerve blocks can be performed for procedures on the upper extremity. The shifting of outpatient surgeries from the hospital to ambulatory surgery centers has placed an emphasis on patient selection and utilizing monitored anesthesia care and regional anesthesia in place of general anesthesia for outpatient procedures.

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Hand ◽  
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.

scholarly journals Prospective Evaluation of Opioid Consumption Following Hand Surgery Performed Wide Awake Versus With Sedation

Hand ◽  
2016 ◽  
Vol 12 (6) ◽  
pp. 606-609 ◽  
Author(s):  
Andrew Miller ◽  
Nayoung Kim ◽  
Asif M. Ilyas
Keyword(s):  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Opioid Consumption ◽  
Anesthesia Care ◽  
Prospective Evaluation ◽  
Opioid Use ◽  
Monitored Anesthesia Care ◽  
Open Carpal Tunnel Release ◽  
Wide Awake ◽  
No Tourniquet

Background: We prospectively evaluated opioid consumption postoperatively following trigger finger release (TFR) and open carpal tunnel release (CTR), and hypothesized that cases performed wide awake with local anesthesia and no tourniquet (WALANT) would result in increased opioid consumption compared with cases performed under monitored anesthesia care (MAC). Methods: Postoperative opioid consumption following CTR and TFR was prospectively collected over 6 months. The primary end points of the study were: (1) total opioid consumption; and (2) the number of days an opioid was used for both groups. Results: Mean opioid use and number of days the opioid was used for all MAC cases were 3.95 pills and 1.8 days, respectively. The results for WALANT were 3.85 pills and 1.6 days. Conclusions: These results suggest that effective pain control postoperatively may be independent of anesthesia type for soft tissue procedures of the hand. Specifically, average opioid consumption and days of utilization were similar in both the MAC and WALANT groups. Average postoperative opioid consumption was approximately only 4 opioid pills. Consideration should be given to prescribing fewer opioids for surgeries such as CTR and TFR.

scholarly journals Minimally invasive carpal tunnel surgery in leprosy

2014 ◽  
Vol 33 (01) ◽  
pp. 42-44
Author(s):  
José Marcos Pondé ◽  
Clarissa Ramos ◽  
Lazaro Santos ◽  
João Pedro Magalhaes ◽  
Ana Flavia Cavalcanti
Keyword(s):  
Developing Countries ◽  
Cost Effectiveness ◽  
Minimally Invasive ◽  
Median Nerve ◽  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Surgical Approach ◽  
Carpal Tunnel Release ◽  
Nerve Involvement ◽  
Carpal Tunnel Surgery

Abstract Objective: Evaluate carpal tunnel release in leprosy. Methods: The authors operated upon 60 patients with median nerve involvement by leprosy between February 2008 and February 2012. The outpatients were under local anesthesia submitted to carpal tunnel release. Results: All the patients showed post-operative improvement in pain and sensation. Conclusion: The surgical approach is a cost effectiveness procedure adequate to developing countries.

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

2017 ◽  
Vol 09 (02) ◽  
pp. 074-079 ◽  
Author(s):  
Nayoung Kim ◽  
Jack Abboudi ◽  
Christopher Jones ◽  
Frederic Liss ◽  
William Kirkpatrick ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Demographic Data ◽  
Syndrome Scale ◽  
Significant Difference ◽  
Tunnel Syndrome ◽  
Without Tourniquet ◽  
Open Carpal Tunnel Release ◽  
Wide Awake

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.

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

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.

scholarly journals Surgical Approach and Anesthetic Modality for Carpal Tunnel Release

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 162-167 ◽  
Author(s):  
Brock D. Foster ◽  
Lakshmanan Sivasundaram ◽  
Nathanael Heckmann ◽  
Jeremiah R. Cohen ◽  
William C. Pannell ◽  
...  
Keyword(s):  
United States ◽  
Local Anesthesia ◽  
Regional Anesthesia ◽  
Carpal Tunnel ◽  
Surgical Approach ◽  
Health Care Cost ◽  
Carpal Tunnel Release ◽  
The United States ◽  
Carpal Tunnel Surgery ◽  
Age Variations

Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

Wide Awake Local Anesthesia No Tourniquet: A Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center

2019 ◽  
Vol 24 (04) ◽  
pp. 389-391
Author(s):  
Ian Jason Castro Magtoto ◽  
David Limlingan Alagar
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Daily Activity ◽  
Carpal Tunnel Release ◽  
Case Series ◽  
Hand Surgery ◽  
Great Success ◽  
Intraoperative Bleeding ◽  
Wide Awake ◽  
No Tourniquet

Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) uses a mixture of lidocaine and epinephrine for anesthesia and has found great success in hand surgery. At the Philippine Orthopedic Center (POC), we still use local anesthesia along with a tourniquet which gives the patient pain and discomfort at the tourniquet site. This study aims to determine perioperative and post-operative pain, intraoperative bleeding and immediate clinical outcomes of patients using WALANT for surgical anesthesia for carpal tunnel release. Methods: A case series of all patients who underwent carpal tunnel release under WALANT from April 2016 to September 2016 is presented. Those with concomitant trigger finger and de quervain disease which required release on the affected hand were also included. A tourniquet was on standby in case of uncontrollable bleeding. Intraoperative bleeding, pain NRS scores, and return to daily activity were noted. Results: Thirteen patients were included in the study; 3 were male, 10 were female. Mean age was 58 years, Mean surgical time was 15 minutes. Twelve were reported to have “some bleeding” and one was reported to have “bleeding but was still manageable”. None of the surgeries were totally bloodless or had too much bleeding that necessitated a tourniquet. Pain NRS scores during injection of local anesthesia had a mean of 2. None of the patients felt pain during and immediately after the surgery. Average time return to daily activity was 6 days. No complications were noted. Conclusions: Patients included in the study who underwent carpal tunnel release under WALANT did not experience pain associated with a tourniquet. Visualization of the field was adequate enough for the surgeons to do the surgery without the need for a tourniquet and with no associated complications.

Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine

Hand ◽  
2019 ◽  
pp. 155894471989003
Author(s):  
Shafic Sraj
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Added Value ◽  
Skin Closure ◽  
Surgical Time ◽  
Operative Complications ◽  
Wide Awake ◽  
No Tourniquet

Background: Wide awake local anesthesia and no tourniquet (WALANT) relies on epinephrine to create a relatively bloodless field. This study evaluated the effect of epinephrine on carpal tunnel release (CTR) surgical time and bleeding, including the need for use of a tourniquet or electrocautery. The hypothesis was that wide awake anesthesia without epinephrine is a viable option for CTR but increases operative time. Methods: Records of all patients who underwent CTR under wide awake anesthesia between October 2017 and September 2018 were reviewed. The injection consisted of either 10 cc of 1% lidocaine with 1:100,000 epinephrine mixed with 1 cc of sodium bicarbonate (8.4%) (WALANT group) or 10 cc of 1% lidocaine (wide awake local anesthesia, no tourniquet and no epinephrine [WALANE] group). The time between skin incision and skin closure was calculated. Tourniquet and electrocautery use as well as operative complications were documented. Results: Thirty-two patients underwent 43 CTRs; 22 CTRs were done under WALANT, and 21 CTRs were done under WALANE. The skin-skin time was 12.8 minute (6-25 minute; standard deviation [SD] = 4.7) for WALANT and 17.4 minute (9-30 minute; SD = 5.8) for WALANE. There was a significant statistical difference (36%) in skin-skin time between the 2 groups. None of the patients required electrocautery or a tourniquet. There were no operative complications. Conclusion: Operative time increased by 36% when epinephrine was not used. Epinephrine is not an absolute necessity to perform wide awake anesthesia but, at the same time, has the added value of decreasing surgical time. Level of evidence: IV

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