scholarly journals Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246863
Author(s):  
Hassanin Jalil ◽  
Florence Polfliet ◽  
Kristof Nijs ◽  
Liesbeth Bruckers ◽  
Gerrit De Wachter ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Intensity ◽  
Nerve Block ◽  
Carpal Tunnel ◽  
Regional Anaesthesia ◽  
Carpal Tunnel Release ◽  
Ultrasound Guided ◽  
Surgical Time ◽  
Randomized Controlled ◽  
Intravenous Regional Anaesthesia

Background and objectives Distal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. Methods In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0–10) was recorded. Surgeon satisfaction with hemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. Results In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. Conclusion An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release. Trial registration This trial was registered as NCT03411551.

Local anaesthesia versus intravenous regional anaesthesia in endoscopic carpal tunnel release: a randomized controlled trial

2012 ◽  
Vol 38 (5) ◽  
pp. 481-484 ◽  
Author(s):  
A. M. Sørensen ◽  
J. Dalsgaard ◽  
T. B. Hansen
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthesia ◽  
Regional Anaesthesia ◽  
Controlled Trial ◽  
Carpal Tunnel Release ◽  
Endoscopic Carpal Tunnel Release ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Intravenous Regional Anaesthesia ◽  
Portal Technique

We carried out a prospective randomized trial in 38 patients to compare intravenous regional anaesthesia with local anaesthesia in endoscopic carpal tunnel release using the Agee single-portal technique. There was no significant difference in reported pain during surgery. Immediately after surgery, patients in the local anaesthesia group reported significantly less pain in the hand and at the tourniquet. Two hours after surgery, patients in the local anaesthesia group reported significantly less hand pain. Moreover, significantly fewer patients in the local anaesthetic group required additional analgesics during the first 2 hours after operation. We conclude that local anaesthesia reduces post-operative pain in endoscopic carpal tunnel release compared with intravenous regional anaesthesia.

Carpal Tunnel Release Under Intravenous Regional or Local Infiltration Anaesthesia

2001 ◽  
Vol 26 (1) ◽  
pp. 67-68 ◽  
Author(s):  
M. M. TOMAINO ◽  
D. ULIZIO ◽  
M. T. VOGT
Keyword(s):  
Carpal Tunnel ◽  
Regional Anaesthesia ◽  
Carpal Tunnel Release ◽  
Tourniquet Time ◽  
Local Infiltration ◽  
Internal Neurolysis ◽  
Patient Tolerance ◽  
Local Infiltration Anaesthesia ◽  
Tunnel Syndrome ◽  
Intravenous Regional Anaesthesia

Fifteen patients with bilateral carpal tunnel syndrome underwent surgery using intravenous regional anaesthesia (IVRA) on one hand and local infiltration anaesthesia (LA) on the other. All 30 carpal tunnel releases were performed without complication. Patient tolerance for IVRA and LA was similar. Six patients preferred the LA, eight preferred IVRA and one had no preference. Tourniquet time averaged 16 minutes when LA was used and 24 minutes with IVRA ( P< 0.05). Use of local anaesthesia allows more expeditious surgery and limits costs, but intravenous regional anaesthesia is recommended if epineurotomy, internal neurolysis or flexor tenosynovectomy are planned.

Ultrasound-guided local corticosteroid injection for carpal tunnel syndrome: A meta-analysis of randomized controlled trials

2021 ◽  
pp. 026921552110147
Author(s):  
Hongchen Wang ◽  
Yuting Zhu ◽  
Hongyu Wei ◽  
Chunke Dong
Keyword(s):  
Adverse Events ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Corticosteroid Injection ◽  
Meta Analysis ◽  
Sensory Nerve ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Tunnel Syndrome ◽  
Local Corticosteroid Injection

Objective: This meta-analysis aimed to compare the efficacy and safety of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) local corticosteroid injection for carpal tunnel syndrome (CTS). Methods: Database including Pubmed, Embase, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs). The outcomes mainly included Boston Carpal Tunnel Questionnaire (BCTQ): Symptom Severity Scale (BCTQs), Functional Status Scale (BCTQf); and electrophysiological indexes: distal motor latency (DML), sensory distal latency (SDL), compound muscle action potential (CAMP), sensory nerve action potential amplitude (SNAP), and sensory nerve conduction velocity (SNCV). Adverse events were also recorded. Results: Overall, nine RCTs were finally screened out with 469 patients (596 injected hands). Pooled analysis showed that US-guided injection was more effective in BCTQs (SMD, −0.69; 95% CI, −1.08 to −0.31; P = 0.0005), BCTQf (SMD, −0.23; 95% CI, −0.39 to −0.07; P = 0.005), CAMP (MD, 0.64; 95% CI, 0.35−0.94; P < 0.0001) improvement, and a lower rate of adverse events (RR, 0.34; 95% CI, 0.22−0.52; P < 0.00001). Subgroup analysis revealed that the US-guided injection had significantly better CMAP than the LM-guided for the in-plane approach (MD, 0.69; 95% CI, 0.36−1.01; P < 0.0001) but not for the out-plane approach (MD, 0.39; 95% CI, −0.39 to 1.17; P = 0.33). Conclusions: US-guided injection was superior to LM-guided injection in symptom severity, functional status, electrodiagnostic, and adverse events improvement for CTS. To some extent, the in-plane approach yields better results compared with the out-plane process under US guidance.

scholarly journals Ultrasound-Guided Surgery for Carpal Tunnel Syndrome: A New Interventional Procedure

2018 ◽  
Vol 35 (04) ◽  
pp. 248-254 ◽  
Author(s):  
Antoine Hakime ◽  
Jonathan Silvera ◽  
Pascal Richette ◽  
Rémy Nizard ◽  
David Petrover
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Interventional Procedure ◽  
Carpal Tunnel Release ◽  
Ultrasound Guided ◽  
Recent Contribution ◽  
Invasive Approach ◽  
Guided Surgery ◽  
Tunnel Syndrome ◽  
Meta Analyses

AbstractCarpal tunnel syndrome (CTS) may be treated surgically if medical treatment fails. The classical approach involves release of the flexor retinaculum by endoscopic or open surgery. Meta-analyses have shown that the risk of nerve injury may be higher with endoscopic treatment. The recent contribution of ultrasound to the diagnosis and therapeutic management of CTS opens new perspectives. Ultrasound-guided carpal tunnel release via a minimally invasive approach enables the whole operation to be performed as a percutaneous radiological procedure. The advantages are a smaller incision compared with classical techniques; great safety during the procedure by visualization of anatomic structures, particularly variations in the median nerve; and realization of the procedure under local anesthesia. These advantages lead to a reduction in postsurgical sequelae and more rapid resumption of daily activities and work. Dressings are removed by the third day postsurgery. Recent studies seem to confirm the medical, economic, and aesthetic benefits of this new approach.

scholarly journals Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Yueying Li ◽  
Wenqi Luo ◽  
Guangzhi Wu ◽  
Shusen Cui ◽  
Xiaossong Gu ◽  
...  
Keyword(s):  
Return To Work ◽  
Randomized Controlled Trials ◽  
Nerve Injury ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Endoscopic Carpal Tunnel Release ◽  
Satisfaction Rates

Abstract Background Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS). We compared the effectiveness and safety of ECTR and OCTR based on evidence from a high-level randomized controlled trial. MethodsWe comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Medline to identify relevant articles published until August 2019. Data regarding operative time, grip strength, Boston Carpal Tunnel Questionnaire scores, digital sensation, patient satisfaction, key pinch strength, return to work time, and complications were extracted and compared. All mean differences (MD) and odds ratios (OR) were expressed as ECTR relative to OCTR. Results Twenty-eight studies were included in our meta-analysis. ECTR was associated with significantly higher satisfaction rates (MD, 3.13; 95% confidence interval [CI], 1.43 to 4.82; P = 0.0003), greater key pinch strengths (MD, 0.79 kg; 95% CI, 0.27 to 1.32; P = 0.003), earlier return to work times (MD, -7.25 days; 95% CI, -14.31 to -0.19; P = 0.04), higher transient nerve injury rates (OR, 4.87; 95% CI, 1.37 to 17.25; P = 0.01), and a lower incidence of scar-related complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). There were no significant differences between the two methods in terms of permanent nerve injury (OR, 1.93; 95% CI, 0.58 to 6.40; P = 0.28). Conclusions Overall, evidence from randomized controlled trials indicates that ECTR results in better recovery of daily life functions than OCTR, as revealed by higher satisfaction rates, greater key pinch strengths, earlier return to work times, and fewer scar-related complications. Our findings suggest that patients with CTS can be effectively managed with ECTR.

scholarly journals Minimum Effective Concentration of Bupivacaine in Ultrasound-Guided Femoral Nerve Block after Arthroscopic Knee Meniscectomy: A Randomized, Double-Blind, Controlled Trial

2016 ◽  
Vol 1;19 (1;1) ◽  
pp. E79-E86
Author(s):  
Rioko K. Sakata
Keyword(s):  
Pain Intensity ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Controlled Trial ◽  
Femoral Nerve ◽  
Pain Intensity Score ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Intensity Score ◽  
Arthroscopic Knee

Background: Adequate analgesia is important for early hospital discharge after meniscectomy. A femoral nerve block may reduce the need for systemic analgesics, with fewer side effects; however, motor block can occur. Ultrasound-guided femoral nerve block may reduce the required local anesthetic concentration, preventing motor block. Objective: The primary objective of this study was to determine the lowest effective analgesic concentration of bupivacaine in 50% (EC50) and in 90% (EC90) of patients for a successful ultrasoundguided femoral nerve block in arthroscopic knee meniscectomy. Study Design: This was a prospective, randomized, double-blind, controlled trial. Settings: This study was conducted at Hospital São Domingos. Methods: A total of 52 patients undergoing arthroscopic knee meniscectomy were submitted to ultrasound-guided femoral nerve block using 22 mL bupivacaine. The bupivacaine concentration given to a study patient was determined by the response of the previous patient (a biased-coin design up–down sequential method). If the previous patient had a negative response, the bupivacaine concentration was increased by 0.05% for the next case. If the previous patient had a positive response, the next patient was randomized to receive the same bupivacaine concentration (with a probability of 0.89) or to have a decrease by 0.05% (with a probability of 0.11). A successful block was defined by a numerical pain intensity scale score < 4 (0 = no pain; 10 = worst imaginable pain) in 3 different evaluations. If the pain intensity score was ≥ 4 (moderate or severe pain) at any time, the block was considered failed. General anesthesia was induced with 30 μg/kg alfentanil and 2 mg/ kg propofol, followed by propofol maintanance, plus remifentanil if needed. Postoperative analgesia supplementation was performed with dipyrone; ketoprofen and tramadol were given if needed. Data Measurements: The following parameters were evaluated: numerical pain intensity score, duration of analgesia, supplementary analgesic dose in 24 hours, and need for intraoperative remifentanil. Results: The EC50 was 0.160 (95% CI: 0.150 – 0.189), and EC90 was 0.271 (95% CI: 0.196 – 0.300). There was no difference in numerical pain intensity score for the different concentrations of bupivacaine. A successful block was achieved in 45 patients, with no difference according to bupivacaine concentration. Time to first analgesic supplementation dose was longer for bupivacaine concentrations ≥ 0.3% (543.8 ± 283.8 min.), compared to 0.25% (391.3 ± 177.8 min.) and < 0.25% (302.3 ± 210.1 min.). There were no differences in supplementary analgesic dose in 24 hours nor in the use of intraoperative remifentanil according to bupivacaine concentration. Limitations: The analgesic effect was measured only during the first 2 hours. Conclusions: Bupivacaine EC50 for ultrasound-guided femoral nerve block was 0.160 (95% CI: 0.150 – 0.189), and EC90 was 0.271 (95% CI: 0.196 – 0.300). Key words: Postoperative analgesia, femoral block, ultrasound-guided, bupivacaíne minimum concentration, arthroscopic meniscectomy

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