Middle East Journal of Family Medicine

Correspondence to:
Dr.Malek Ghnaimat
E-mail :malek_ghnaimat@yahoo.com

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ABSTRACT

Objective: Our aim is to determine the effectiveness and patient's tolerance of local infiltration anesthesia in carpal tunnel release surgery.

Methods: This study was done in the period between March 2006 and November 2006 at the Princess Haya Military Hospital in Aqaba, and sixteen patients with carpal tunnel syndrome were included. 10 ml 1% lignocaine was infiltrated into the skin and subcutaneous tissue with arm tourniquet. Patients' pain from tourniquet and surgery site was assessed.

Results: The mean duration of surgery was less than 15 minutes. 4(25%) of patients reported mild tolerable pain due to tourniquet and 3 patients reported it at the site of surgery but with no supplemental anesthesia used. No complication of the anesthesia or the surgery was encountered. Six week follow up of patients showed complete relief of symptoms.

Conclusion: Local infiltration anesthesia is a safe, rapid and well accepted, and tolerated by patients in carpal tunnel release surgery.

INTRODUCTION

Carpal tunnel is the most commonly diagnosed and treated entrapment neuropathy with pain, paresthesia and weakness at the distribution of the median nerve in the hand (1).Treatment modalities were either conservative versus surgical release, open or endoscopic (2,3).

Different anesthesia modalities reported for carpal tunnel release (CTS) include intravenous regional, distal nerve block at wrist and local infiltration anesthesia (4,5,6).

This is a prospective study to determine the efficacy and patients' tolerance of local anesthesia infiltration (LA) in CTS release surgery.

This study was done in the period between March 2006 and November 2006 at the Princess Haya Military Hospital in Aqaba. 16 patients with signs and symptoms of carpal tunnel syndrome and EMG findings of moderate to severe degrees, with failed conservative treatment were included in the study. Exclusion criteria included prior CTS release on the involved hand; known mass, tumor or deformity; diabetes mellitus, rheumatoid diseases; and pregnancy or lactation.

A 25-gauge needle was used to infiltrate a 10 ml 1% lignocaine into the skin and the underlying subcutaneous tissue without involving the flexor retinaculum to avoid needlestick injury to the median nerve. The hand was then cleaned, draped and the tourniquet inflated after the arm was exsanguinated. The median nerve was decompressed through a skin incision made along the thenar area by releasing the transverse carpal ligament and the skin closed by absorbable 5/0. Patients were followed up in clinic after one week and six weeks.

The tourniquet pain and pain during surgery was evaluated using the four- level score with 0=no pain; 1=mild pain; 2=moderate pain; and 3=severe pain.

In the study, 11patients were females with a mean of age 30 years and 5 males with a mean age of 42 years.

The mean duration of surgery was less than 15 minutes. There was no pain at site of surgery in 81.25% of patients with mild pain in 3 patients but no supplemental anesthesia was needed during surgery as shown in Table I.

Moderate and severe tourniquet pain were not experienced and the pain was experienced during the inflation of the tourniquet. 4 (25%) of patients reported mild pain but there was no need to decrease the pressure as shown in Table 1.

All patients reported good relief of symptoms after 6 week follow up and satisfaction with the local anesthesia. No complication of anesthesia or surgery was detected.

Carpal tunnel syndrome (CTS) release can be either open or endoscopic with limited evidence to suggest a significant difference, although open release is with fewer complications (7). Various anesthetic techniques have been reported including local anesthesia, intravenous regional and block at wrist anesthesia (4,5,6,7).

Local infiltration anesthesia is a more practical, rapid, safe technique with least complications, as we found in our study (6,8) .

A bloodless field is essential in CTR and arm tourniquet is the choice but tourniquet pain may become intolerable if applied more than 30 minutes (9). The 4 patients experienced a tolerable mild tourniquet pain and did not need any analgesia or pressure release.

In our study, the anesthesia infiltration was to skin and subcutaneous tissue and not deep to avoid needle stick injury or edema around the synovial sheath as reported (8).

Local anesthesia can be used in uncomplicated CTR surgeries while other techniques as IV regional anesthesia can be used in case epineurolysis or tenosynovectomy is needed (6).