Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Mar;8(1):47-53.
doi: 10.1007/s11552-012-9474-5.

The patient's perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study

Peter G Davison  1 , Tyson Cobb  2 , Donald H Lalonde  1
Affiliations

The patient's perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study

Peter G Davison et al. Hand (N Y). 2013 Mar.

Abstract

Background: The purpose of this study was to provide prospective independently analyzed evidence on how patients feel about a carpal tunnel release (CTR) performed under local anesthesia only (no sedation or tourniquet) versus with local anesthesia, intravenous (IV) sedation, and a tourniquet.

Methods: This prospective cohort study compared 100 consecutive CTRs done with only lidocaine and epinephrine in Saint John, New Brunswick to 100 consecutive CTRs done with IV sedation in Davenport, Iowa. Patient perspectives on the anesthesia were captured in a blinded questionnaire 1 week postoperatively.

Results: For subsequent surgery, 93 % of wide awake patients would choose local anesthesia only and 93 % of sedated patients would choose sedation. Wide awake patients spent less time at the hospital (M = 2.6 h) than sedated patients (M = 4.0 h; p < .001). Preoperative blood work, electrocardiograms, and/or chest radiographs were done for 3 % of wide awake patients and 48 % of sedated patients (p < 0.001). Preoperative anxiety levels for wide awake patients were lower than for sedated patients (p = 0.007); postoperative anxiety was similar. There were no anesthesia complications in either group. Narcotics were used by 5 % of unsedated patients and 67 % of sedated patients (p < 0.001). Adequate pain control was reported by 89 % and 90 % of patients, respectively.

Conclusions: The majority of patients from both cohorts liked whichever method of anesthesia they received and would choose it again. However, sedated patients spent more time at the hospital, required more preoperative testing, and reported greater preoperative anxiety.

Keywords: Carpal tunnel release; Carpal tunnel syndrome; Intravenous sedation; Local anesthesia; Patient preference; Patient satisfaction; Wide awake.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Patient questionnaire. The 12-item questionnaire completed by patients 1 week postoperatively
Fig. 2
Fig. 2
Postoperative analgesics. a Distribution of postoperative analgesic medications used by patients in the wide awake cohort. b Distribution of postoperative analgesic medications used by patients in the IV sedation cohort
Fig. 3
Fig. 3
Method of anesthesia of choice for subsequent CTR. Responses of patients from both cohorts, on their method of anesthesia of choice for a hypothetical subsequent carpal tunnel release
See this image and copyright information in PMC

References

    1. Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350(24):2441–2451. doi: 10.1056/NEJMoa032196. - DOI - PMC - PubMed
    1. Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–158. doi: 10.1001/jama.282.2.153. - DOI - PubMed
    1. Chatterjee A, McCarthy JE, Montagne SA, et al. A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States. Ann Plast Surg. 2011;66(3):245–248. doi: 10.1097/SAP.0b013e3181db7784. - DOI - PubMed
    1. Farhangkhoee H, Lalonde J, Lalonde DH. Wide-awake trapeziectomy: video detailing local anesthetic injection and surgery. Hand (N Y) 2011;6(4):466. doi: 10.1007/s11552-011-9367-z. - DOI - PMC - PubMed
    1. Gelfman R, Melton LJ, 3rd, Yawn BP, et al. Long-term trends in carpal tunnel syndrome. Neurology. 2009;72(1):33–41. doi: 10.1212/01.wnl.0000338533.88960.b9. - DOI - PMC - PubMed