Comparison between Wide-Awake and Conventional Anesthetic Technique for the Carpal Tunnel Release: Pain and Satisfaction of the Patient in Short Term Period

Background: The purpose of this study is to compare wide awake technique anesthesia suggested by Lalonde to conventional tourniquet assisted anesthesia in carpal tunnel release, with regard to pain immediate after surgery and perception of pain 2 weeks and 6 weeks after the surgery.

Methods: A randomized controlled blind prospective study of 30 patients. The diagnosis of CTS was based on history, physical findings, provocative test (Tinel’s sign), and EMG. Two groups: conventional with lidocaine and tourniquet and wide awake technique. Local anesthesia was performed, and the patient was assessed by VAS score. At the recovery room and in outpatient clinic 2 and 6 weeks after the surgery, patient asked to evaluate VAS score and willingness to get the same anesthesia in the future.

Results: 53% wide awake anesthesia (16/30) and 47% conventional anesthesia (14/30). Half patients with wide awake anesthesia needed additional anesthesia during the procedure (p<0.05). Survey questions: does the pain is less or more than expected? At a 2 week checkup wide awake method 9 patients (56%) felt that it was more and 7(45%) confirmed that it was less than expected. In the group with conventional anesthesia only one patient felt more pain than was expected (p<0.05). If similar procedure will be needed in the future, would you choose the same anesthesia? At a 2 week checkup 31% of patients with wide-awake method had poor experience and will not choose the same method next time, on the other hand only 9% of conventional anesthetic method not interested in the same anesthesia method, same results after 6 weeks. In both groups VAS score decreased.

Conclusion:Patients with wide awake anesthesia experienced more pain and were more reluctant to do the same anesthesia in the future compared to the conventional tourniquet anesthesia method.