Open Carpal Tunnel Decompression Research Articles

Comparative study of surgical wound closure with nylon interrupted sutures and running subcuticular vicryl rapide suture after open release of the carpal tunnel.

BackgroundSurgical decompression of the carpal tunnel is considered the method of choice for its treatment with satisfactory results documented. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared interrupted mattress closure by means of nylon suture to running subcuticular closure with vicryl rapide suture. As far as we know, there is no similar study in the literature.MethodsA total of twenty patients were included in the study. Ten of them had their surgical wound closed with 3.0 nylon suture in an interrupted fashion and for the rest, a running subcuticular 3.0 vicryl rapide was used. All patients filled in a questionnaire about VAS perceived pain and a Quick DASH score sheet, preoperatively, at two and six weeks postoperatively. The cosmesis of the scar was assessed using the POSAS v2.0 system at two and six weeks after surgery and overall incidence of infections was noted as well.ResultsThere was no statistically important difference between the two groups of patients in regards to postoperative VAS pain levels at two and six weeks. Likewise, no statistically significant difference was evident as far as Quick DASH score, POSAS score and infections were concerned.ConclusionsOur results suggest that the use of running subcuticular vicryl rapide suture is an attractive alternative to interrupted nylon sutures for closure after open carpal tunnel decompression, lacking any significant drawbacks.Lay SummarySurgery for carpal tunnel decompression is considered the method of choice for its treatment with documented satisfactory results. Various methods and suturing materials have been used for closure of the surgical wound. In the present study, we compared the use of a non-absorbable suture, placed intermittently to an absorbable continuous intradermal suture. A total of twenty patients were included in the study. Half of them had their wound closed with the absorbable suture and the other half with the non-absorbable suture, as described above. All patients were evaluated as far as pain, scar characteristics, functional outcomes of the operated hand and incidence of infection, at two and six weeks after surgery. After analysis of the data, no significant differences were found between the two groups, suggesting that both of these techniques are equally safe and efficacious.

Hyaluronidase to Reduce Pain from Local Anaesthetic Infiltration for Carpal Tunnel Decompression.

Abstract Aims: The aim of this prospective cohort study is to investigate the effect of hyaluronidase on pain experienced during local anaesthetic infiltration for carpal tunnel decompression. Methods: Two cohorts of twenty consecutive patients each underwent carpal tunnel release by a single surgeon over a five-month period. The first twenty patients received a local anaesthetic solution of lignocaine and adrenaline whilst the second group received a mixture of lignocaine, adrenaline and hyaluronidase (Hyalase®). All consecutive patients booked for simple open carpal tunnel decompression under local anaesthesia were included. Patients with other compressive neuropathies, generalised neuropathies or other concomitant hand pathologies were excluded from the study. The primary outcome measurement was pain experienced during local anaesthetic infiltration. Patients were asked to indicate the level of pain felt using a visual analogue scale (VAS) between 0 (no pain) to 10 (maximum pain they can imagine). Secondary outcome measures were operating time, measured as tourniquet time and early complication rates. Results: Patients administered local anaesthesia with hyaluronidase experienced significantly less pain on infiltration of the proximal palm (p < 0.05) and distal palm (p < 0.05) compared to those that did not receive hyaluronidase. Infiltration of the palm was the most painful part of the procedure for both groups. There was no statistically significant difference in pain reported on initial needle insertion (p = 0.95) or on infiltration of the distal forearm (p = 0.10). No patients in either group required additional local anaesthetic. The mean tourniquet time for the group receiving local anaesthesia without hyaluronidase was 3.79 minutes (range 3 to 5 minutes, SD 0.71) versus to 3.65 minutes (range 3 to 5 minutes, SD 0.67) for the hyaluronidase group. There was therefore no significant difference in operating time between the two cohorts (p = 0.53). No early complications were observed in either groups. Conclusion: This study finds that hyaluronidase is effective at reducing pain during local anaesthetic infiltration for carpal tunnel release. We therefore recommend its routine use.

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

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.

Résultats fonctionnels et qualité de vie après révision décompression du canal carpien

This study describes functional outcomes, patient satisfaction, and health-related quality of life (HRQoL) following open revision carpal tunnel decompression (CTD) for recurrent carpal tunnel syndrome (CTS). Postoperative results were available for 16 hands in 15 patients (100% at mean follow-up at 19.9 months). This was a prospective study at a single-centre serving a population of 360,000. QuickDASH, patient satisfaction, and EQ-5D-5L questionnaires were collected pre and postoperatively for patients undergoing revision CTD over a five-year period (2013–2018). The incidence of revision CTD was 0.9 per 100,000 patients per year. Fifteen patients reported recurrent and 1 patient-reported persistent symptoms. Median time to revision was 12.5 years (interquartile range 6.7–15.7 years). Mean preoperative and postoperative quickDASH was 57.7 and 36.1, respectively. The overall mean improvement in QuickDASH was 28.1. The mean improvement in EQ-5D-5L was 0.17. Thirteen patients (81.8%) were satisfied. The Net Promoter Score was 87.5. This study confirms the widely-held view that patients with late-presenting CTS can expect to enjoy a similar improvement in function and HRQoL as patients undergoing primary CTD. Recurrent CTS presents following a long symptom-free period after primary CTD, and hand function regresses to a similar level of disability. These results can be used to counsel patients who are considering revision surgery.

Decompression for recurrent carpal tunnel syndrome provides significant functional improvement and patient satisfaction.

This prospective single-centre study describes the functional outcomes, satisfaction and health-related quality of life after open revision carpal tunnel decompression for recurrent carpal tunnel syndrome. The QuickDASH, patient satisfaction and EuroQol-5 dimensions questionnaires were collected preoperatively and postoperatively over a 5-year period (2013-2018). The median time to revision was 13.3 years (range 3.9-35.4 years; interquartile range 7.2-15.9 years). Outcomes were available for 14 hands in 13 patients at a mean of 20 months after revision surgery. The mean preoperative and postoperative QuickDASH scores were 55 and 29, respectively, and the mean improvement in QuickDASH was 26. The mean improvement in EuroQol-5 dimensions score was 0.1, and 13 of the 14 patients were satisfied. The net promoter score was 85. This study confirms that patients undergoing revision open carpal tunnel decompression for recurrent carpal tunnel syndrome experience a significant improvement in function and health-related quality of life. Level of evidence: IV.

Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery.

Carpal tunnel syndrome is a common problem and surgical decompression of the carpal tunnel is the most effective treatment. After surgical decompression, the palmar skin may be closed using either absorbable or non-absorbable sutures. To date, there is conflicting evidence regarding the ideal suture material and this formed the rationale for our review. To assess the effects of absorbable versus non-absorbable sutures for skin closure after elective carpal tunnel decompression surgery in adults on postoperative pain, hand function, scar satisfaction, wound inflammation and adverse events. We searched the following databases on 30 October 2017: the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, and Embase. We searched two clinical trials registries on 30 October 2017. We considered all randomised or quasi-randomised controlled trials comparing absorbable and non-absorbable sutures for skin closure after any form of carpal tunnel decompression surgery in adults. The unit of analysis was the hand rather than the patient. We performed meta-analysis of direct comparisons to generate standardised mean differences (SMDs) with 95% confidence intervals (CIs) in pain scores and risk ratios (RRs) with 95% CIs for dichotomous outcomes, such as wound inflammation. The primary outcome was postoperative pain. Secondary outcomes included hand function, scar satisfaction, scar inflammation and adverse events (complications). We assessed the quality of evidence for key outcomes using GRADE. We included five randomised trials (255 participants). The trials were all European (UK, Republic of Ireland, Denmark and the Netherlands). Where quoted, the mean age of participants was between 48 and 53 years. The trials measured outcomes between one and 12 weeks postoperatively.Meta-analysis of postoperative pain scores for absorbable versus non-absorbable sutures at 10 days following open carpal tunnel decompression (OCTD) produced a SMD of 0.03 (95% CI -0.43 to 0.48; 3 studies, number of participants (N) = 137; I2 = 43%); the SMD suggests little or no difference, but with a high degree of uncertainty because of very low-quality evidence. At 10 days following endoscopic carpal tunnel decompression (ECTD), the SMD for postoperative pain with use of absorbable versus non-absorbable sutures was -0.81 (95% CI -1.36 to -0.25; 1 study; N = 54); although the SMD is consistent with a large effect, the very low-quality evidence means the results are very uncertain. Only the OCTD studies provided pain data at 6 weeks, when the SMD was 0.06 (95% CI -0.72 to 0.84; 4 studies; N = 175; I2 = 84%), which indicates little or no evidence of difference, but with a high degree of uncertainty (very low-quality evidence). The RR for wound inflammation using absorbable versus non-absorbable sutures after OCTD was 2.28 (95% CI 0.24 to 21.91; N = 95; I2 = 90%) and after ECTD 0.93 (95% CI 0.06 to 14.09; 1 study, N = 54). Any difference in effect on wound inflammation is uncertain because the quality of evidence is very low. One study reported postoperative hand function but found no evidence of a difference between suture types at two weeks (mean difference (MD) -0.10, 95% CI -0.53 to 0.33, N = 36), with similar findings at six and 12 weeks. Only the ECTD trial reported scar satisfaction, with 25 out of 28 people reporting a 'nice' result in the absorbable-suture group, versus 18 out of 26 in the group who received non-absorbable sutures (RR 1.29, 95% CI 0.97 to 1.72, N = 54). These findings are also very uncertain as we judged the quality of the evidence to be very low. All studies were at high risk of bias for most domains. No trials reported adverse events. It is uncertain whether absorbable sutures confer better, worse or equivalent outcomes compared to non-absorbable sutures following carpal tunnel decompression, because the quality of evidence is very low. Use of absorbable suture eliminates the need for suture removal, which could confer considerable savings to patients and healthcare providers alike. We need rigorously-performed, non-inferiority randomised trials with economic analyses to inform choice of suture.

The Influence of the Type of Surgical Thread and Suture in the Open Carpal Tunnel Syndrome Surgery

AbstractCarpal tunnel syndrome (CTS) is the result of compression and/or traction of the median nerve in the carpal tunnel. It is the most frequent compressive neuropathy of the upper limbs and it is usually idiopathic. Diagnosis is essentially clinical, defined by symptoms and provocative tests. Decompression of the median nerve by section of the transverse carpus ligament is the treatment of choice, but the lack of consensus on the type of suture and surgical thread to be used in the open carpal tunnel decompression surgery justifies the importance of evaluating the comparative results of existing studies, aiming to describe the influence of different types of sutures and surgical threads to guide the professionals about the most appropriate conduct. This is a systematic review of the international and national literature. Four studies comparing the influence of surgical threads and one study evaluating the influence of the type of suture were found. From the comparative studies, it was observed that there is advantage in the use of nonabsorbable suture due to the lower occurrence of inflammation and postoperative wound complications. When using Donatti sutures, wound edge inversion is less likely to occur compared with single individual sutures, but they are also related to longer postoperative pain.

Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction.

We studied the correlation between change in the QuickDASH score and the absolute post-operative QuickDASH score with patient satisfaction after open carpal tunnel decompression. Threshold values in the QuickDASH score, the point at which the sensitivity and specificity are maximal in predicting patient satisfaction, were identified. During the study period, outcome data were compiled for 937 carpal tunnel decompressions, which included 219 (23%) male and 718 (77%) female patients with a mean age of 58 years (standard deviation (SD) 14). There was a significant improvement (mean difference 32, 95% confidence interval (CI) 30 to 34) in the QuickDASH from a mean of 54 (SD 20) to 22 (SD 23) at 1 year after surgery. There were 808 (86%) patients who defined their outcome as satisfactory at 1 year. The identified threshold values for the post-operative QuickDASH score (⩽34 points) and the change (⩾20 points) in the score were highly predictive of patient satisfaction. However, these threshold values varied significantly according to the baseline pre-operative score. The threshold values identified in the QuickDASH can be used to interpret the score. However, the influence of the pre-operative baseline score should be taken into account when comparing different cohorts of patients or using the values to power future studies. Prognosis, observational cohort study.

Open Carpal Tunnel Decompression by Specialist versus Nurse Practitioner

To compare the outcome after open carpal tunnel decompression by specialists versus a nurse practitioner. Of 1361 cases of open carpel tunnel decompression under local anaesthesia from 1996 to 2008, 807 were performed by specialists (consultant, specialist registrar, or specialty and associate specialist) and 554 by a nurse practitioner (since May 2006). The 2 groups were compared in terms of surgical time, total theatre time, postoperative pain, and patient satisfaction with the service. The mean surgical time was shorter in cases performed by specialists (13 vs. 18 minutes, p<0.0001), as was the mean total theatre time (26 vs. 29 minutes, p=0.0154). The rate of postoperative pain was higher in cases performed by specialists (31.5% vs. 24.5%, p=0.0125), as was the rate of patient dissatisfaction (1.6% vs. 0.18%, 0.0113). Nonetheless, since May 2006, outcome was comparable for specialists and the nurse practitioner. This could be due to the change from short-acting to long-acting/mixed local anaesthetic, and the technique for infiltration. The waiting time for surgery reduced from a mean of 16 to 3 weeks. Specialists and the nurse practitioner achieved comparable outcome after open carpal tunnel decompression.

Study to Assess Outcome After Open and Closed Carpal Tunnel Decompression

Carpal tunnel decompression (CTD) is the most commonly performed surgical procedure within a hand unit. We have analyzed data on outcomes after carpal decompression performed by both open and closed techniques to assess whether outcomes differed between the 2 procedures. Data were jointly gathered from 2 units. The aim was to assess the outcome after CTD. Completed data were gathered from 621 CTD procedures performed on 484 patients. Of the procedures, 358 were performed via a standard open CTD technique and 263 procedures were performed via a closed single-port Agee technique. Assessments were performed by means of the Levine-Katz questionnaire, Semmes-Weinstein monofilament testing, grip strength, and pinch-grip strength testing. Assessments were performed both preoperatively and 6 months postoperatively. A randomly selected 10% of patients were also assessed at 12 months. The results were statistically better after closed CTD at the 6-month postoperative stage. However, the difference became less marked by 12-month postoperative stage. Our results show that CTD whether performed by an open or closed technique resulted in a similar outcome at the 12-month postoperative stage. However, those procedures performed by a closed technique offered a more rapid recovery in the first 6 months postoperative than by an open technique.

Pedicled hypothenar fat pad flap in recalcitrant carpal tunnel syndrome

The incidence of failure in open carpal canal tunnel decompression is underestimated. Recurrence is often the result of scarring of the median nerve. Conservative treatment or careful neurolysis are usually insufficient.

Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome

This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes. The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens. There weren't any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p < 0.05). Because of the severe synovial and epineurial histopathological abnormalities and inadequate neural regeneration capacity, surgical open carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.

Arm versus forearm tourniquet for carpal tunnel decompression - Which is better? A randomized controlled trial.

Tourniquet pain is a common source of complaint for patients undergoing carpal tunnel decompression and practice varies as to the tourniquet position used. There is little evidence to suggest benefit of one position over another. Our aim was to compare patient and surgeon experience of forearm and arm tourniquets. Following a power calculation, 100 patients undergoing open carpal tunnel decompression under local anaesthetic were randomized to either an arm or a forearm tourniquet. Measurements of blood pressure, heart rate and pain were taken at 2.5 min intervals. The operating surgeon also provided a visual analogue scale rating for the extent of bloodless field achieved and for any obstruction caused by the tourniquet. There was no statistically significant inter-group difference in patient pain or physiological response, tourniquet time, bloodless field or length of procedure. The degree of obstruction caused by the tourniquet was significantly higher in the forearm group. I. Prospective Randomized Controlled Trial.

Subjective outcome evaluations following open carpal tunnel release

Objective To evaluate the effects of open carpal tunnel decompression performed on patients with carpal tunnel syndrome (CTS),using subjective questionnaires.Methods Open carpal tunnel release procedure was performed in 26 CTS patients from April 2008 to October 2011.Four questionnaires (Levine,DASH,UEFI and SF-36) were adopted preoperatively and at least 6 months after the surgery to assess the symptoms and function of the hands as well as psychosocial function of the patients.Results The postoperative mean Levine symptom-severity score,Levine functional-status score,DASH score and UEFI score were 1.41 ± 0.54 (2.90 ± 0.87 preoperatively),1.28 ± 0.39 (2.58 ± 1.19 preoperatively),9.01 ± 15.29 (30.61 ± 18.12 preoperatively),and 73.92 ± 10.29 (57.27 ± 16.26 preoperatively).All categories of SF-36 scores showed obvious improvements,among which improvements of the psychological and social function were most remarkable.Numbness and nocturnal symptoms were ameliorated significantly.Fine hand motor functions were improved more notably than gross movement of the upper limbs.Conclusion Open carpal tunnel decompression can significantly alleviate the symptoms,improve hand functions,promote rehabilitation of psychosocial finctions and enhance the quality of life of CTS patients. Key words: Carpal tunnel syndrome; Follow-up studies; Open carpal tunnel decompression; Levine; DASH; SF-36; UEFI

Effectiveness and safety of endoscopic versus open carpal tunnel decompression

To evaluate the effectiveness and safety of endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) using a meta-analysis of data from randomized controlled trials. Electronic searches of the Cochrane Register of Controlled Trials (CENTRAL, Issue 11 of 12, Nov 2012), PUBMED (1980 to Dec 2012), and EMBASE (1980 to Dec 2012) were used to identify randomized controlled trials that evaluated endoscopic vs open methods for treatment of carpal tunnel syndrome. Studies to be used were independently identified by two researchers. The methodological quality of the studies was assessed by the Cochrane Collaboration tool for assessing risk of bias. Fifteen randomized controlled trials involving 1,596 hands were included. Based on the Cochrane Collaboration tool for assessing risk of bias, four studies were rated as high quality, five studies were rated as moderate quality, and six were rated as low quality. Our meta-analysis indicated that ECTR resulted in better recovery of pinch strength, earlier time of return to work, but a higher rate of reversible nerve problems (including neurapraxia and numbness) than OCTR. ECTR also resulted in a lower rate of irreversible nerve damage (P > 0.05), wound problems (including wound infection, wound hematoma and wound dehiscence) and reflex sympathetic dystrophy (P > 0.05) compared with OCTR. Our meta-analysis revealed no obvious statistical differences in relief of symptoms (pain and paraesthesia), recovery of grip strength and reoperation rate. Our meta-analysis of available randomized controlled trials demonstrated that ECTR and OCTR were similar in relief of symptoms, but ECTR resulted in better recovery of function and earlier return to work and was safer than OCTR.

Modified Altissimi and Mancini technique for carpal tunnel decompression

Introduction: Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia. Methods: Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia. Results: Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury. Conclusion: We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique. DOI: http://dx.doi.org/10.3126/joim.v34i1.9116 Journal of Institute of Medicine, April, 2012; 34:1 9-12

Modified Altissimi and Mancini technique for carpal tunnel decompression

Introduction: Carpal tunnel syndrome is the commonest compressive peripheral nerve neuropathy; open carpal tunnel decompression still remains the preferred method as a day case procedure using local &nbsp;anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The purpose of this study was to evaluate the efficacy of the modified Altissimi and Mancini technique of local anesthesia. Methods: Fourteen hands of twelve patients age ranged from 26 to 55 years, two patients with bilateral involvements were recruited. Most involved hand was operated first with the modified Altissimi and Mancini technique of local anaesthesia. Results: Intra-operative pain was evaluated using visual analog score. Patients experienced no to very little intra-operative pain VAS 0- 2. Only one patient experienced tourniquet discomfort which subsided after release. There was neither any intra-operative nor during follow up, the signs of iatrogenic median nerve injury. Conclusion: We concluded that open carpal tunnel decompression using modified Altissimi and Mancini technique under local anaesthesia and with tourniquet control is a safe, effective and acceptable novel technique. DOI: http://dx.doi.org/10.3126/joim.v34i1.9116 Journal of Institute of Medicine, April, 2012; 34:1 9-12

A comparison of the functional difficulties in staged and simultaneous open carpal tunnel decompression

There is no agreement about whether patients with bilateral carpal tunnel syndrome should undergo staged or simultaneous open decompression. The purpose of this study was to quantify and compare the functional difficulties during the recovery from surgery for patients undergoing staged or simultaneous decompressions. Sixty-three patients had surgery; 33 had staged decompression (Group 1) and 30 simultaneous decompressions (Group 2). Functional difficulties were recorded using the Levine and Quick-DASH scores along with a visual analogue score for pain. There were no complications in either group. There was no significant difference in terms of pain or satisfaction. Functional difficulties were greater in the simultaneous group; however, there was no difference in completing simple tasks. Patients reported high satisfaction with either management approach. However, significantly fewer would consider undergoing simultaneous decompression again.

Patient satisfaction with tourniquet application and local anaesthesia infiltration in carpal tunnel decompression and the relationship with overall satisfaction

This was a prospective study designed to determine what effect poor tolerance to tourniquet application and local anaesthesia infiltration in open carpal tunnel decompression has on overall patient satisfaction with the surgical procedure. Fifty patients were recruited into the study. Visual analogue scores (VAS) were recorded postoperatively for pain related to tourniquet application, local anaesthesia infiltration and the surgical procedure overall. In terms of the procedure, poor tolerance to the tourniquet and local anaesthetic showed no significant relationship to the overall patient satisfaction (Student t-test). The factors, which are related to satisfaction with carpal tunnel decompression, are discussed.

The Effect of Buffered Lidocaine in Local Anesthesia: A Prospective, Randomized, Double-Blind Study

Open carpal tunnel decompression under local anesthesia is routinely done by many surgeons. However, patients complain of pain during the injection of local anesthesia. This prospective, double-blind, randomized study was to compare the pain visual analog scale (VAS) scores of local anesthesia using lidocaine with and without sodium bicarbonate in patients with bilateral carpal tunnel syndrome. Twenty-five patients underwent bilateral simultaneous carpal tunnel decompression. All had topical anesthetic cream applied on the palm and wrist before the lidocaine block. In a randomized manner, half of the hands were blocked with nonbuffered lidocaine and half were blocked with buffered lidocaine. Pain was evaluated on a VAS score. The mean pain VAS score in the hand with buffered lidocaine was 4.6 ± 1.5 and 6.5 ± 1.5 for the hand with nonbuffered lidocaine. After adjustment for individual threshold of the pain, the mean pain VAS score changed into 4.6 ± 1.3 with buffered lidocaine and 6.6 ± 1.7 without buffered lidocaine. In open carpal tunnel surgery, the use of buffered lidocaine for local anesthesia reduces the anesthetic pain effectively. Therapeutic I.