scholarly journals Patients’ Perspective on Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia

2021 ◽  
Vol 147 (5) ◽  
pp. 887e-888e
Author(s):  
Alper Aytaç ◽  
Can Ilker Demir ◽  
Murat Şahin Alagöz
Keyword(s):  
Regional Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Intravenous Regional Anesthesia ◽  
Patients Perspective

Subcutaneous local anesthesia versus intravenous regional anesthesia for endoscopic carpal tunnel release: a randomized controlled trial

2011 ◽  
Vol 114 (1) ◽  
pp. 240-244 ◽  
Author(s):  
Abdullah Nabhan ◽  
Wolf-Ingo Steudel ◽  
Lutfi Dedeman ◽  
Jehad Al-Khayat ◽  
Basem Ishak
Keyword(s):  
Operating Room ◽  
Regional Anesthesia ◽  
Carpal Tunnel ◽  
Controlled Trial ◽  
Carpal Tunnel Release ◽  
Tourniquet Time ◽  
Endoscopic View ◽  
Intravenous Regional Anesthesia ◽  
Endoscopic Carpal Tunnel Release ◽  
Endoscopic Release

Object This study compares the effectiveness of subcutaneous infiltration of a local anesthetic agent (LA) versus intravenous regional anesthesia (IVRA) during endoscopic carpal tunnel release. Methods Forty-four patients suffering from severe symptoms restricting normal daily activities—such as persistent loss of feeling in the fingers or hand, or no strength in the thumb in spite of prolonged nonsurgical treatment—and with electromyographically proven carpal tunnel syndrome were enrolled in this study. All underwent endoscopic carpal tunnel release. Twenty-two patients had an endoscopic release of the median nerve under LA (LA Group). The other 22 patients underwent the surgery after intravenous induction of regional anesthesia (IVRA Group). The operating room in-out time and tourniquet time were evaluated in both groups. The patients were also asked to evaluate the pain associated with the tourniquet during surgery using a visual analog scale. The Michigan Hand Outcomes Questionnaire was used to assess the functional outcome preoperatively and at both 2 weeks and 6 months postoperatively. Results One patient in the LA Group needed an additional application of prilocaine, whereas 3 patients in the IVRA Group needed additional LA and 1 of these required propofol. The tourniquet time and operating room time were significantly lower in the LA Group (p = 0.01 for both). There were no complications related to the endoscopic surgery. The Michigan Hand Outcomes Questionnaire did not show significant differences between the groups at either postoperative follow-up examination. Conclusions Endoscopic carpal tunnel release with subcutaneous infiltration of LA was well tolerated and effective. Injection-associated problems such as increased thickness of the synovial layer or impaired endoscopic view did not occur.

scholarly journals Tourniquet Deflation Prior to 20 Minutes in Upper Extremity Intravenous Regional Anesthesia

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 223-227 ◽  
Author(s):  
Richard W. Gurich ◽  
Justin W. Langan ◽  
Robert J. Teasdall ◽  
Stephanie L. Tanner ◽  
John L. Sanders
Keyword(s):  
Upper Extremity ◽  
Regional Anesthesia ◽  
Postoperative Nausea ◽  
Carpal Tunnel Release ◽  
Cohort Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Tourniquet Time ◽  
Intravenous Regional Anesthesia ◽  
Tourniquet Deflation ◽  
Bier Block

Background: Bier blocks, or intravenous regional anesthesia (IVRA), are a method of anesthesia for upper extremity surgeries. This study reports our experience with tourniquet deflation prior to 20 minutes with upper extremity IVRA. Methods: This study was designed as a retrospective cohort analysis. Records, including intraoperative and immediate postoperative anesthesia notes, of 430 patients who underwent IVRA with an upper extremity Bier block and a corresponding tourniquet time of less than 20 minutes were reviewed. Patient demographics, procedure(s) performed, American Society of Anesthesiologists scores, volume of lidocaine used in Bier block, tourniquet time, and any complications were recorded. Results: This cohort consisted of 127 males and 303 females. The 3 most common procedures performed were carpal tunnel release (315), trigger finger release (47), and excision of masses (34). The average tourniquet time for this cohort was 16 minutes (range, 9-19 minutes), and the average volume of lidocaine (0.5% plain) injected was 44 mL (range, 30-70 mL). A tourniquet time of 17 minutes or less was observed in 339 patients, and 170 patients had tourniquet times of 15 minutes or less. Five complications were recorded: intraoperative vomiting, mild postoperative nausea/vomiting, severe postoperative nausea and vomiting, and transient postoperative hypotension that responded to a fluid bolus. Conclusions: No major complications were observed in our cohort of upper extremity IVRA and tourniquet times of less than 20 minutes. Several variables play a role in the safety of upper extremity IVRA.

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.

scholarly journals Intravenous Regional Anesthesia Using a Forearm Tourniquet: A Safe and Effective Technique for Outpatient Hand Procedures

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 353-359 ◽  
Author(s):  
Natalie Vaughn ◽  
Niraja Rajan ◽  
Michael Darowish
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Carpal Tunnel Release ◽  
Direct Injection ◽  
University Hospital ◽  
Tourniquet Time ◽  
Patient Demographics ◽  
Intravenous Regional Anesthesia ◽  
Included Patient ◽  
Bier Block

Background: Bier block provides anesthesia of an entire extremity distal to the tourniquet without necessitating direct injection at the surgical site. This avoids obscuring anatomy with local anesthetic and anesthetizes a wide area, allowing for multiple procedures and incisions. We hypothesize that a low-volume Bier block with forearm tourniquet, rather than a traditional brachial tourniquet, is a safe, well-tolerated, and effective anesthesia technique. Methods: All cases in which adult patients underwent hand procedures using Bier block anesthesia by a single surgeon over a 4-year period were reviewed. Data collected included patient demographics, procedure(s) performed, complications, tourniquet time and settings, procedure and in-room time, and supplemental medications administered. Results: In all, 319 patients were included, 103 from a university hospital and 216 from an ambulatory surgery center. The most commonly performed procedures were carpal tunnel release (205 cases) and trigger digit release (83 cases). Most patients received a 125-mg dose of lidocaine for the Bier block; many also received additional sedatives. Twenty-three patients received no additional medications. No patients required conversion to general anesthesia. One complication (0.3%) occurred, with paresthesias and tinnitus that resolved without intervention. The average tourniquet time was 24 minutes (SD = 4.3 minutes). Patients were discharged at a median of 49 minutes postoperatively, and 9.1% of patients received supplemental analgesics prior to discharge. Conclusions: Regional anesthesia achieved with a forearm tourniquet and intravenous local anesthetic provides adequate pain control, permits timely discharge home, and has a low complication rate. It should be considered for use in outpatient hand procedures.

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

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