Surgical Approach and Anesthetic Modality for Carpal Tunnel Release

Abstract

Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery

“…OCTR and ECTR techniques have been described as both safe and effective with equivalent results in the short-term, 4–7 although ECTR may be costlier. 8,9 With regard to anesthetic type, performing CTR under local anesthetic without sedation has been shown to be effective, 10–14 while other anesthetic methods including Bier block, monitored anesthesia care (MAC), or general anesthesia are also well-established options.…”

“…A recent study utilizing payment data from United Health Group insurance records concluded that OCTR performed under local anesthetic was less costly than other methods of CTR. 9 However, surgical setting (OR versus PR) was not included as a study variable. 9…”

Comparison of Turkish and international trends in carpal tunnel surgery

“…It was demonstrated that endoscopic surgery was, on average, $794 more expensive than open surgery. [ 7 ] In The American Academy of Orthopedic Surgery (AAOS) guidelines, it was reported that endoscopic techniques have limited short-term benefits compared to open techniques. [ 8 ]…”

“…Turkish surgeons were less likely to prefer WALANT because there is no local procedure room in many clinics and an anesthesiologist is often present in the general operating room. Foster et al[ 7 ] reported that general or regional anesthesia cost $654 more than local anesthesia.…”

Comparison of Wide Awake Local Anaesthesia No Tourniquet Technique with Tourniquet Application under General Anesthesia in Carpal Tunnel Syndrome: A Retrospective Study

“…Anesthesia and surgical techniques may vary according to surgeon preferences and patient-related factors (3). Despite the increasing popularity of local anesthetic methods, general and regional anesthesia techniques are still widely used (4). While elderly patients prefer local methods, younger patients often prefer general anesthesia (5).…”