A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial

Abstract

Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia. The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression. Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixtysix patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre-intra-and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted. Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated shorttime inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort. Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.

Comparison of Wrist Arthroscopy, Small Incision Surgery, and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Retrospective Study at a Single Center

“…Recent developments in the surgical treatment of carpal tunnel syndrome have resulted in improved surgical techniques to reduce postoperative pain and improve cosmesis. In small incision surgery, the transverse carpal ligament can also be excised to fully decompress the carpal tunnel, which leads to improved efficacy, particularly in terms of functional improvement and reduced scar hyperplasia [10–12]. Also, in small incision surgery, the requirements for surgical instruments and equipment are low, the surgical approach is simpler, tissue damage is smaller, and the medical costs are lower [13].…”

A 15-Year Review of Clinical Practice Patterns in Carpal Tunnel Syndrome Based on Continuous Certification by the American Board of Plastic Surgery

“…Direct comparisons between regional and local anesthesia conducted thus far have indicated a slight physician preference for local techniques because of their simplicity, lower cost, and patient preference due to motor function preservation. 69,70 Flexor tenosynovectomy (5 percent) and intraoperative steroid injection (2 percent) were reported in the tracer; however, their efficacy in augmenting carpal tunnel release is unknown (Table 3). [71][72][73][74] Studies performed thus far have indicated no significant differences in patient outcomes following the use of these adjunctive treatments.…”