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

Overview

Journal J Hand Microsurg

Date 2021 Apr 19

PMID 33867768

Citations 1

Authors

Nikolaos Karamanis

Georgia Stamatiou

Dionysia Vasdeki

Nikolaos Sakellaridis

Konstantinos C Xarchas

Sokratis Varitimidis

Zoe H Dailiana

Affiliations

Soon will be listed here.

Abstract

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. 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. 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. 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.

Citing Articles

Optimization of Carpal Tunnel Syndrome Using WALANT Method.

Segal K, Debasitis A, Koehler S J Clin Med. 2022; 11(13).

PMID: 35807138 PMC: 9267271. DOI: 10.3390/jcm11133854.

References

Atanassoff P, Ocampo C, Bande M, Hartmannsgruber M, Halaszynski T . Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient surgery. Anesthesiology. 2001; 95(3):627-31. DOI: 10.1097/00000542-200109000-00013. View

Serra J, Benito J, Monner J . Carpal tunnel release with short incision. Plast Reconstr Surg. 1997; 99(1):129-35. DOI: 10.1097/00006534-199701000-00020. View

Benson L, Bare A, Nagle D, Harder V, Williams C, Visotsky J . Complications of endoscopic and open carpal tunnel release. Arthroscopy. 2006; 22(9):919-24, 924.e1-2. DOI: 10.1016/j.arthro.2006.05.008. View

Scarfone R, Jasani M, Gracely E . Pain of local anesthetics: rate of administration and buffering. Ann Emerg Med. 1998; 31(1):36-40. DOI: 10.1016/s0196-0644(98)70278-1. View

Koppert W, Ostermeier N, Sittl R, Weidner C, Schmelz M . Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain. 2000; 85(1-2):217-24. DOI: 10.1016/s0304-3959(99)00268-7. View

Alter T, Warrender W, Liss F, Ilyas A . A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation. Plast Reconstr Surg. 2018; 142(6):1532-1538. DOI: 10.1097/PRS.0000000000004983. View

Yiannakopoulos C . Carpal ligament decompression under local anaesthesia: the effect of lidocaine warming and alkalinisation on infiltration pain. J Hand Surg Br. 2004; 29(1):32-4. DOI: 10.1016/s0266-7681(03)00223-7. View

Lawrence T, Desai V . Topical anaesthesia to reduce pain associated with carpal tunnel surgery. J Hand Surg Br. 2002; 27(5):462-4. DOI: 10.1054/jhsb.2002.0823. View

Avramidis K, Lewis J, Gallagher P . Reduction in pain associated with open carpal tunnel decompression. J Hand Surg Br. 2000; 25(2):147-9. DOI: 10.1054/jhsb.2000.0363. View

10.

Vossinakis I . Re: reduction in pain associated with open carpal tunnel decompression. J Hand Surg Br. 2001; 26(5):503-4. DOI: 10.1054/jhsb.2001.0640. View

11.

Wehbe M . Transverse carpal ligament. An important component of the digital flexor pulley system. J Bone Joint Surg Am. 1993; 75(10):1575-6. DOI: 10.2106/00004623-199310000-00019. View

12.

Kuschner S, Brien W, Johnson D, Gellman H . Complications associated with carpal tunnel release. Orthop Rev. 1991; 20(4):346-52. View

13.

Lichtman D, Florio R, Mack G . Carpal tunnel release under local anesthesia: evaluation of the outpatient procedure. J Hand Surg Am. 1979; 4(6):544-6. DOI: 10.1016/s0363-5023(79)80007-6. View

14.

Dupont C, CIABURRO H, PREVOST Y, Cloutier G . Hand surgery under wrist block and local infiltration anesthesia, using an upper arm tourniquet. Plast Reconstr Surg. 1972; 50(5):532-3. DOI: 10.1097/00006534-197211000-00028. View

15.

Rose M, Kam P . Gabapentin: pharmacology and its use in pain management. Anaesthesia. 2002; 57(5):451-62. DOI: 10.1046/j.0003-2409.2001.02399.x. View

16.

Tulipan J, Kim N, Abboudi J, Jones C, Liss F, Kirkpatrick W . Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation. J Hand Microsurg. 2017; 9(2):74-79. PMC: 5579466. DOI: 10.1055/s-0037-1603200. View

17.

Altissimi M, Mancini G . Surgical release of the median nerve under local anaesthesia for carpal tunnel syndrome. J Hand Surg Br. 1988; 13(4):395-6. DOI: 10.1016/0266-7681_88_90163-5. View

18.

Vossinakis I, Stavroulaki P, Paleochorlidis I, Badras L . Reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. J Hand Surg Br. 2004; 29(4):399-401. DOI: 10.1016/j.jhsb.2003.12.009. View

19.

Turan A, Karamanlioglu B, Memis D, Hamamcioglu M, Tukenmez B, Pamukcu Z . Analgesic effects of gabapentin after spinal surgery. Anesthesiology. 2004; 100(4):935-8. DOI: 10.1097/00000542-200404000-00025. View

20.

Steinberg R, Reuben S, Gardner G . The dose-response relationship of ketorolac as a component of intravenous regional anesthesia with lidocaine. Anesth Analg. 1998; 86(4):791-3. DOI: 10.1097/00000539-199804000-00021. View