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

Abstract

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.

One portal simultaneous bilateral endoscopic carpal tunnel release under local anaesthesia. Do the results justify the effort?

“…This difference has been mainly attributed to the additional volume of instruments under the intact flexor retinaculum that might cause pressure on the nerve. Nabhan et al [13] and Sorensen et al [14] infiltrated the subcutaneous area of palmar proximal wrist as well as the distal wrist down to the palm before endoscopic surgery. In both studies, no significant problems with visibility during endoscopic division of the transverse carpal ligament were reported.…”

“…There were no complications related to the endoscopic surgery and the hand functional outcome was equal in both groups during follow up examination. In another prospective randomised trial, Sorensen et al [14] compared intravenous regional anaesthesia with local anaesthesia in endoscopic carpal tunnel release using the Agee singleportal technique. There was no significant difference in reported pain during surgery.…”

Update/Review

“…37 A third trial provided level II evidence that local anesthesia reduces postoperative pain in endoscopic carpal tunnel release compared with intravenous regional anesthesia. 38 All 3 of the above studies also pointed out that endoscopic carpal tunnel can be easily performed with local anesthetic infiltration into the operative site.…”

Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation

“…This study was conducted at Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.…”

“…These efforts have included utilizing less invasive surgical techniques, moving the surgeries to outpatient facilities 1 and using portable hand tables to improve turnover time and efficiency, eliminating postoperative physical therapy 2 and postoperative splinting, 3 and simplifying perioperative anesthesia. 4,5 A 2015 study polled members of the American Society of Surgeons of the Hand and found that 43% of respondents use intravenous sedation during CTR, whereas 8% perform the surgery with local anesthesia alone leaving the patient wide awake. 6 The "wide-awake local anesthesia with no tourniquet" (WALANT) anesthesia technique has gained attention in recent years due to its convenience, cost-effectiveness, [7][8][9] and high level of patient satisfaction.…”