Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia

Barros, Marco Felipe Francisco Honorato; Luz Júnior, Aurimar da Rocha; Roncaglio, Bruno; Queiróz Júnior, Célio Pinheiro; Tribst, Marcelo Fernandes

doi:10.1016/j.rboe.2015.12.001

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Original Articles • Rev. bras. ortop. 51 (1) • jan-feb 2016 • https://doi.org/10.1016/j.rboe.2015.12.001 copy

Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia^{^☆} ☆ Work developed by the Department of Orthopedics and Traumatology, Universidade do Oeste Paulista (UNOESTE), and Orthopedics and Traumatology Service, Hospital Regional de Presidente Prudente, Presidente Prudente, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate.

MATERIAL AND METHODS:

This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure.

RESULTS:

The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01). In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia.

CONCLUSION:

Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result.

Keywords:
Carpal tunnel syndrome; Local anesthesia; Epinephrine

Patient	Sex	Age	Side operated	Dominance	Occupation	Length of time with symptoms (years)
1	F	54	R	R	Cleaner	5
2	F	34	R	R	Cleaner	4
3	M	53	L	L	Farm laborer	4
4	F	51	R	R	Caretaker	2
5	F	51	R	R	Homemaker	6
6	F	53	L	R	Cook	4
7	F	57	R	R	Homemaker	5
8	M	64	L	R	Handyman	2
9	F	48	R	R	Domestic service	3
10	F	59	R	R	Homemaker	3
11	F	43	R	R	Farm laborer	3
12	F	51	R	L	Handyman	6
13	F	72	L	R	Homemaker	6
14	F	49	L	R	Typist	4
15	F	42	R	R	Cleaner	4
16	M	52	L	R	Human resources analyst	10

Mean	F = 13 M = 3	52.063	R = 10 L = 6	R = 14 L = 2		4.4375

Clinical characteristics	Patients (n = 16)
Duration of symptoms, in years (mean±SD)	4 ± 2

Side affected, n (%)
Right	10 (63)
Left	6 (37)

Dominant limb, n (%)
Right	14 (88)
Left	2 (12)

Characteristics of the anesthesia	Patients (n = 16)
Number of pain episodes (mean±SD)	1.25 ± 0.4
Intensity of pain (mean±SD)	2 ± 2.3

Dental procedure, n (%)
Better	13 (81)
Worse	3 (19)

Venous puncture, n (%)
Same	4 (25)
Better	8 (50)
Worse	4 (25)

Other anesthesia, n (%)
Do not know	3 (19)
Better	12 (75)
Worse	1 (6)

Patient	DASH before operation	DASH 6 months after operation
1	73.3	16.66
2	50.8	2.2
3*	65.8	NS
4	79.3	29.41
5	74.1	13.97
6	72.5	35.8
7*	53.3	NS
8	70	1.66
9	67.5	13.97
10	70.8	4.16
11	45	25
12	75.8	37.5
13	56.7	2.2
14	68.3	2.94
15	56.7	16.91
16	51.7	29.16

Mean	65.17857143	16.53857143
Standard deviation	10.81567087

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail:marcofelipebarros@hotmail.com (M.F.F.H. Barros).