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.

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.

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.

Early Outcome and Cost-Effectiveness of Endoscopic Versus Open Carpal Tunnel Release: A Randomized Prospective Trial

2003 ◽  
Vol 28 (5) ◽  
pp. 444-449 ◽  
Author(s):  
N. L. B. SAW ◽  
S. JONES ◽  
L. SHEPSTONE ◽  
M. MEYER ◽  
P. G. CHAPMAN ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Prospective Trial ◽  
Cost Effective ◽  
Early Outcome ◽  
Endoscopic Carpal Tunnel Release ◽  
Carpal Tunnel Surgery ◽  
Significant Difference ◽  
Open Carpal Tunnel Release

Proponents of endoscopic carpal tunnel release have been advocating the technique for more than 10 years but there is still debate about its efficacy, safety and cost-effectiveness. We have performed a randomized, prospective, blind trial to compare early outcome after single portal endoscopic or open carpal tunnel surgery and to assess the cost-effectiveness of the procedures. There were no significant differences in symptom and functional activity scores, grip strength or anterior carpal pain in the first 3 months. For those in employment, we found a statistically significant difference between the two treatment groups with the endoscopic group returning to work, on average, 8 (95% CI, 2–13 days) days sooner than the open group. This translates into a cost saving to industry. There were no major neurovascular complications in either group. On the basis of these findings, we recommend that endoscopic carpal tunnel release should be considered in the employed as a cost-effective procedure, but perhaps not in the general population as a whole.

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

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 Does the Duration and Severity of Symptoms Have an Impact on Relief of Symptoms after Carpal Tunnel Release?

2019 ◽  
Vol 14 (01) ◽  
pp. e1-e8
Author(s):  
Mehreen Masud ◽  
Mamoon Rashid ◽  
Saleem Malik ◽  
Muhommad Ibrahim Khan ◽  
Saad-ur-Rehman Sarwar
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Normal Function ◽  
Duration Of Symptoms ◽  
Compressive Neuropathy ◽  
Carpal Tunnel Surgery ◽  
Short Period ◽  
Group 2 ◽  
Open Carpal Tunnel Release

Rationale Carpal tunnel syndrome (CTS) is the most frequently encountered compressive neuropathy of the upper limb. The treatment of CTS ranges from conservative management to carpal tunnel release. Many patients with misconception about the potential morbidity and with the hope of successful conservative treatment delay the surgical release of carpal tunnel. This delay results in reduced recovery of sensory and motor median nerve function. Objective The aim of this study was to evaluate the influence of preoperative duration and severity of symptom on the outcome of carpal tunnel surgery. Method It included 45 cases of CTS, all treated with limited access open carpal tunnel release. The duration of symptoms (i.e., pain, numbness, tingling, waking up at night because of pain/numbness, difficulty in grasping small objects, and their preoperative severity) was noted using Boston CTS questionnaire. To investigate the outcome, patients were divided into three groups based on their duration of symptoms. Result Group1: The severity of symptoms was reduced to normal in a short period of time in patients who presented with duration of symptoms less than 6 months. Group 2: Patients in whom symptoms lasted for 6 to 12 months had reduced or delayed recovery of hand function as compared with first group. Group 3: Patients who had symptoms for more than 12 months had incomplete recovery of grip strength. Return to normal function took the longest time (median: 16 weeks) in this group. Conclusion This study suggests that patients who present late have delayed/incomplete relief of symptoms after carpal tunnel release.

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 Trigger Fingers After Open Carpal Tunnel Release

2020 ◽  
Vol 28 (4) ◽  
pp. 192-195
Author(s):  
Duffield Ashmead ◽  
Haruko Okada ◽  
Jonathan Macknin ◽  
Steven Vander Naalt ◽  
Ilene Staff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Specific Treatment ◽  
Trigger Thumb ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
Compensation Status ◽  
Open Carpal Tunnel Release

Trigger finger (TF) and carpal tunnel syndrome (CTS) are common conditions often occurring together with an unclear relationship. While some studies conclude that TFs occur as a result of carpal tunnel release (CTR), others have not established a causal relationship. Our purpose was to evaluate the prevalence and timing of TF development in the same hand after open CTR in our population. This was a retrospective review of 497 patients undergoing open CTR by a single surgeon. Two hundred twenty-nine charts were analysed for age, gender, handedness, BMI, workers’ compensation status, and background disease. We analysed the specific digit involved and timing to development of triggering after CTR. Thirty-one patients developed triggering after CTR (13.5%). Mean age was 52.5 (14.0) years. Follow-up ranged from 1 to 53 months with a median follow-up of 6 months (interquartile range = 2-13). The thumb was the most common to trigger (42.22%), followed by the ring 24.44%, middle 22.22%, little 8.89%, and index fingers 2.22%. Trigger thumb occurred at 3.5 months (3.6) post-operatively, while other digits triggered at 7.5 months (4-10.25) after surgery ( P = .022). No risk factors were associated with TF development. Our results suggest that a trigger thumb develops more frequently and earlier than other trigger digits after an open CTR. Further study is needed to clarify the mechanisms involved and may enable specific treatment such as local anti-inflammatory medication following CTR. We suggest educating prospective carpal tunnel surgery patients to high risk of triggering following CTR.

Neurophysiology not Required Before Surgery for Typical Carpal Tunnel Syndrome

2001 ◽  
Vol 26 (1) ◽  
pp. 61-64 ◽  
Author(s):  
V. FINSEN ◽  
H. RUSSWURM
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Diagnosis ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Neurophysiological Tests ◽  
Carpal Tunnel Surgery ◽  
Neurophysiological Studies ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Sixty-eight patients with typical carpal tunnel syndrome underwent neurophysiological investigations preoperatively, but these were not assessed until the end of the study. Open carpal tunnel release was performed and the clinical diagnosis of carpal tunnel syndrome was considered as confirmed when there was a prompt resolution of the preoperative symptoms. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. The neurophysiological tests were normal in these two patients, but were also normal in 14 of the 63 patients who improved with carpal tunnel surgery. Preoperative neurophysiology might therefore have led to up to 14 of the 63 cases of carpal tunnel syndrome being turned down for surgery. We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance.

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