Comparing Superficial vs. Deep Local Anesthetic Infiltration To Improve Patient Experience During Carpal Tunnel Release

OrthoMedia ◽  
2022 ◽  
Keyword(s):  
Patient Experience ◽  
Carpal Tunnel ◽  
Local Anesthetic ◽  
Carpal Tunnel Release ◽  
Local Anesthetic Infiltration ◽  
Improve Patient

scholarly journals Tourniquet Use in Wide-Awake Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 59-63 ◽  
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.

Cost Savings of Carpal Tunnel Release Performed In-Clinic Compared to an Ambulatory Surgery Center: Time-Driven Activity-Based-Costing

Hand ◽  
2019 ◽  
pp. 155894471989004
Author(s):  
Melissa White ◽  
Harsh R. Parikh ◽  
Kelsey L. Wise ◽  
Sandy Vang ◽  
Christina M. Ward ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Local Anesthetic ◽  
Ambulatory Surgery ◽  
Carpal Tunnel Release ◽  
Cost Savings ◽  
Activity Based Costing ◽  
Ambulatory Surgery Center ◽  
Pain Scores ◽  
Surgery Center ◽  
Clinic Group

Purpose: The purpose of our study was to investigate carpal tunnel release (CTR) performed in the clinic versus the ambulatory surgery center (ASC) to evaluate for potential cost savings. Methods: Patients who underwent either CTR in clinic under a local anesthetic or CTR in the ASC with sedation and local anesthetic were prospectively enrolled in a registry between 2014 and 2016. All patients completed a Visual Analog Scale (VAS) pain scale for procedural and postprocedure pain. Time-Driven Activity-Based Costing (TDABC) was utilized to quantify cost of both CTR in clinic and CTR in the ASC. Statistical analysis involved parametric comparative tests between patient cohorts for both the TDABC-cost and patient pain. Results: A total of 59 participants completed the postprocedure CTR survey during the study period, 23 (38.9%) in the ASC group and 36 (61.1%) in the clinic group. Overall time for the procedure from patient arrival to discharge was significantly longer for the ASC cases, averaging 215.7 minutes (range: 201-230) compared to 78.6 minutes (range: 59-98) in the clinic group ( P < .01). Both procedural and postoperative VAS pain scores were comparable between clinic and ASC cohorts, procedural pain: 1.8 vs 1.9 ( P = .91) and postoperative pain: 4.8 vs 4.9 ( P = .88). TDABC analysis estimated ASC CTR procedures to cost an average of $557.07 ($522.06-$592.08) and clinic procedures to cost an average of $151.92 ($142.59-$161.25) ( P < .05). Conclusions: CTR in the clinic setting results in significant cost savings compared to CTR in the ASC with no difference in pain scores during the procedure or postoperative period. Level of Evidence: Therapeutic Level II.

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.

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.

Experiences with Endoscopic Carpal Tunnel Release

Swiss Surgery ◽  
2002 ◽  
Vol 8 (4) ◽  
pp. 181-185
Author(s):  
Buchli ◽  
Scharplatz
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Endoskopische Karpaltunnelspaltung

Im Spital Thusis wurden zwischen 1994 und 2000 122 Patienten wegen eines Karpaltunnelsyndroms operiert. Wir wollten wissen, ob die endoskopische Karpaltunnelspaltung in einem Regionalspital mit genügend hoher Sicherheit angewandt wurde und ob die Ergebnisse mit der offenen Karpaltunnelspaltung vergleichbar sind. In einer retrospektiven Studie konnten wir 82 Patienten mittels Fragebogen über das Operationsergebnis befragen. 39 Patienten wurden offen operiert, 26 mittels der Zweipfortentechnik nach Chow und 17 mittels Einpfortentechnik nach Agee. Schwere irreversible Komplikationen wurden nicht beobachtet. Bezüglich der Operationsergebnisse zeigten sich keine signifikanten Unterschiede in den drei Gruppen. Von den 39 offenen Karpaltunnelspaltungen klagten neun Patienten über Restbeschwerden, wobei es zu einer Reoperation wegen einer Thenarastverletzung kam. Bei den 26 endoskopischen Karpaltunnelspaltungen in Zweipfortentechnik traten bei acht Patienten Restbeschwerden auf, wobei eine Reoperation wegen exzessiver Vernarbung durchgeführt werden musste. Bei den 17 Operationen nach Agee hatten fünf Patienten Restbeschwerden, es musste jedoch keiner reoperiert werden. Die Studie zeigt, dass mit den drei unterschiedlichen Operationsverfahren bezüglich Sicherheit und Therapieerfolg vergleichbare Resultate erreicht wurden. Vorteile wegen dem atraumatischeren Zugang der endoskopischen Techniken konnten wir jedoch nicht objektivieren.

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