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2008 | 80 | 11 | 615-620
Tytuł artykułu

A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia.The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression.Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixty-six patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre- intra- and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted.Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated short-time inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort.Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.
Wydawca

Rocznik
Tom
80
Numer
11
Strony
615-620
Opis fizyczny
Daty
wydano
2008-10-01
online
2010-05-04
Twórcy
  • Department of General and Hand Surgery, Pomeranian Medical University in Szczecin
  • Department of General and Hand Surgery, Pomeranian Medical University in Szczecin
  • Department of General and Hand Surgery, Pomeranian Medical University in Szczecin
  • Department of General and Hand Surgery, Pomeranian Medical University in Szczecin
Bibliografia
  • Żyluk A, Strychar J: A comparison of two limited open techniques for carpal tunnel release. J Hand Surg 2006; 31B: 466-72.[WoS]
  • Lichtman DM, Florir RL, Mack GR: Carpal tunnel release under local anaesthesia: evaluation of the outpatient procedure. J Hand Surg 1979; 4A: 544-46.
  • Vossinakis IC: Reduction in pain associated with open carpal tunnel decompression (letter). J Hand Surg 2001; 26B: 503-04.
  • Sinha A, Chan V, Anastakis DJ: Anaesthesia for carpal tunnel release. Can J Anaesth 2003; 50: 323-27.[PubMed]
  • Altissimi M, Mancini GB: Surgical release of the median nerve under local anaesthesia for carpal tunnel syndrome. J Hand Surg 1988; 13B: 395-96.
  • Gibson M: Outpatient carpal tunnel decompression without tourniquet: a simple local anaesthetic technique. Ann R Coll Surg Engl 1990; 72: 408-09.
  • Delanuay L, Chelly E: Blocks at the wrist provide effective anesthesia for carpal tunnel release. Can J Anaesth 2001; 48: 656-60.
  • Gale DW: Surgical decompression of the carpal tunnel using infiltrative anaesthesia: description of technique. J Royal Coll Surg Edinb 1991; 36: 341.
  • Watts AC, Gaston P, Hooper G: Randomized trial of buffered versus plain lidocaine for local anaesthesia in open carpal tunnel decompression. J Hand Surg 2004; 29B: 30-31.
  • Watts AC, McEachan J: The use of a fine-gauge needle to reduce pain in open carpal tunnel decompression: a randomized controlled trial. J Hand Surg 2005; 30B: 615-17.
  • Vossinakis IC, Stavroulaki P, Paleochorlidis I et al.: Reducing the pain associated with local anaesthetic infiltration for open carpal tunnel decompression. J Hand Surg 2004; 29B: 399-401.
  • Yiannakopoulos CK: Carpal ligament decompression under local anaesthesia: the effect of lidocaine warming and alcalisation on infiltration pain. J Hand Surg 2004; 29B: 32-43.
  • Braitwaithe BD, Robinson GJ, Burge PD: Haemostasis during carpal tunnel release under local anaesthesia: a controlled comparison of tourniquet and adrenaline infiltration. J Hand Surg 1993; 18B: 184-86.
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_v10035-008-0085-3
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