gms | German Medical Science

Objectives/Interrogation: A recent development in Hand Surgery is the use of epinephrine-local anesthesia without tourniquet. This method is allegedly safe and allows checking digital mobility. The goal of this study is to assess the intra and postoperative efficacy and comfort of this innovative anesthesia in 2 groups of patients with carpal tunnel release (CTR).

Interrogations were: Incidence of arm pain, complications, amount of bleeding, patient satisfaction, length of hospital stay.

Methods: 66 CTR were performed through a mini-open approach, divided in 2 groups: a) n=27: 2% lydocain + 0.5% bupivacaine + epinephrine 1:200.000 + light sedation by anesthesiologist; b) n=39: 2% lydocaine + epinephrine 1:200.000.

Descriptive, comparative, retrospective, observational study through a phone inquiry on: 1) Pain at needle prick, injection or during sugery; 2) Additional anesthetic requirement; 3) Length of analgesia; 4) Dyspnea; 5) Brachialgia; 6) Nausea - Vomiting; 7) Hospitalization; 8) Care by a family member; 9) Time to eating; 10) Post-op medication; 11) Sleep quality; 12) Dressing staining; 13) Future choice of a different anesthesia.

Results and Conclusions: There were 66 patients: 17 males and 49 females, with a mean age of 66.9 ys. (21-90), operated on between 2008 and 2018.

All the cases were performed on an outpatient basis. Post-op hospital stay was 1-3 hours.

Bleeding was minimal and did not hinder the surgery.

All the patients were satisfied and would choose this procedure instead of general o regional anesthesia. They did not report intra or post-op side-effects, regardless of the group which they belonged to. They also did not show statistic difference regarding comfort. Anesthesia length was mostly more than 6 hours, especially with the addition of bupivacaine.

CTR under local lydocaine + epinephrine, without tourniquet, has been safe and with no complications. Bleeding was minimal and visualization clear. Bupivacaine addition lengthens the analgesia time. Benefits for patients were: No intra nor immediate postoperative pain, neither local nor at the usual placement of the tourniquet; and less hospital stay. The inherent simplicity of the operating room should reduce costs. Though the participation of an anesthesiologist is adviceable, it is not mandatory, depending on local regulations. We do not recommend performing the surgery outside an operating room, nor to omit a pre-surgical evaluation.