Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

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.

Optimization of Carpal Tunnel Syndrome Using WALANT Method

“…Kang et al and Iqbal et al found patients who underwent CTR with WALANT reported similar postoperative functional outcomes as compared with comparison groups who received general anesthesia or wide-awake anesthesia with a tourniquet [62,65]. Interestingly, Karamanis et al showed that functional outcomes after CTR with WALANT did not differ regardless of the type of local anesthetic used [36].…”

“…Thus, it is possible that WALANT could be associated with more surgical site infections. However, no studies to date have demonstrated higher infection rates when WALANT has been used, regardless of operative location, type of sterility used, or composition of personnel present for the procedure [29,30,33,[35][36][37][38][39].…”

A membrane‐protected micro‐solid‐phase extraction method based on molecular imprinting and its application to the determination of local anesthetics in cosmetics

“…However, LAs in the tertiary form are uncharged and lipid‐soluble and can readily cross nerve membranes in the human body [2]. All LAs have a common structure containing a lipophilic aromatic ring and hydrophilic amine group connected to an intermediary group as a mediator [3]. LAs can be classified in terms of the intermediary group into amino esters and amino amides [4]; the chemical properties of LAs are listed in Table S1.…”