Local only Surgery for Patients with Carpal Tunnel Syndrome

Carpal Tunnel with local only (WALANT)

 

OPEN Carpal Tunnel Surgery Can be done with local medication only.

Among the many advances in local anesthesia of the hand, some of the most significant changes in the last few years have been the following: (1) the acceptance of safety of locally infiltrated epinephrine with lidocaine for hemostasis, which has removed the need for sedation, brachial plexus blocks, and general anesthesia for most common hand surgery operations and minor hand trauma.

Like dental procedures, wide awake hand surgery can be performed with  no intravenous sedation, .The surgeon injects into the hand  a mixture of   only 2 medications; lidocaine for anesthesia and epinephrine for hemostasis.

No need to fast or change medication schedules

Patients with sore elbows, shoulders or backs can position themselves comfortably.

After the surgery less time is needed  as there is no need  to recover from sedation or unnecessary opiates.

Studies have shown that having carpal tunnel release without sedation or under local only does not increase the need for postoperative opiods, in fact many patients who have open carpal tunnel surgery under local only do not need post operative opiod or use very little.

OPIOID USE FINDINGS FOR  NEEDS IN OPEN CARPAL TUNNEL SURGERY ARE MINIMAL

Prospective Evaluation of Opioid Consumption Following OpenCarpal Tunnel Release Surgery.

Conclusions: Opioid consumption following CTR is more influenced by age and gender, and less influenced by anesthesia type, insurance type, or the type of opioid prescribed. Many more opioids were prescribed than needed, on an average of 5:1. Many patients, particularly older patients, do not require any opioid analgesia after CTR.

 

 

KNOW THE RISKS AND BENEFITS OF SURGERY AND UNDERSTAND THE SURGERY

read the AAOS INFORMED PATIENT TUTORIAL ON CARPAL TUNNEL  from which the below is based upon:

Risks and Complications

The complication rate following carpal tunnel release is very low. Most complications, if they occur, are minor and can be treated. However there are rare instances where more severe complication occur.

It is important that you know and understand the risks before you make the decision to have surgery. Possible surgical complications include:

  • Infection
  • Persistent symptoms
  • Recurrent symptoms
  • Major nerve injury/numbness

Infection

Infection is possible with any surgery. Rates of infection in carpal tunnel release surgery are considered to be extremely low. If an infection does occur, it is typically treated with oral antibiotics. Occasionally, surgery may be needed to clean out the infected area.

Some surgeons give antibiotics before and/or after surgery. Studies have shown that rates of infection after carpal tunnel surgery are the same, whether antibiotics are given or not.

Persistent Symptoms

In some cases, carpal tunnel syndrome symptoms continue even after surgery. Typical reasons for this include:

  • An incomplete release of the transverse carpal ligament
  • A mass within the carpal tunnel
  • Long-standing disease which has caused severe damage to the nerve
  • Nerve compression in areas outside the carpal tunnel, such as the neck or elbow
  • Disease of the nerve itself or "neuropathy" that is not caused by compression

Persistent symptoms may require further investigation for other causes. They may require an additional surgery, which is called a revision surgery.

Recurrent Symptoms

A return of symptoms after a period of relief is possible after carpal tunnel release.

Recurrent symptoms can be caused by scar formation around the median nerve. The nerve may also scar down to surrounding structures within the carpal tunnel. Portions of the transverse carpal tunnel ligament may re-form and cause pressure on the nerve. The synovial tissue which surrounds the tendons may thicken over time causing further squeezing of the nerve.

Return of symptoms, if significant, may be a reason to undergo a revision of the original carpal tunnel surgery. Depending on the cause, the outcome of revision surgery may not be as good as the original surgery.

Your surgeon will discuss with you what to expect if further surgery is required.

Major Nerve Injury

Irreversible damage to the median nerve, branches of the median nerve, or nearby nerves are among the most serious complications of carpal tunnel surgery. Fortunately, the chance of this type of complication is less than 0.5%.

If a nerve injury does occur, there can be pain and permanent loss of feeling and function. Further surgeries may be necessary to try and improve these symptoms.