CARPAL TUNNEL RELEASE
Carpal Tunnel Release is a surgical procedure performed to relieve the pressure on the median nerve in the wrist, which can cause pain, numbness, and tingling in the hand and fingers. This condition is called carpal tunnel syndrome (CTS) and is caused by the compression of the median nerve in the wrist.
The procedure involves making a small incision on the palm side of the wrist and cutting the transverse carpal ligament to create more space for the median nerve. This can be performed through a traditional open incision or through a minimally invasive endoscopic procedure.
The recovery from carpal tunnel release surgery varies from person to person, but most people experience a significant improvement in their symptoms after the procedure. Physical therapy and hand exercises may be recommended to help improve wrist and hand strength and range of motion.
Anesthetic Implications for Carpal Tunnel Release
Anesthesia type: MAC sedation and a local anesthetic. Regional anesthesia with Bier block or brachial plexus block
Airway: Natural airway
Preoperative:
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Never use Bupivacaine with a Bier block due risk of cardiotoxicity
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Place the blood pressure cuff on the nonoperative arm
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Intravenous regional anesthesia is suitable for procedures that are < 1 hour
Intraoperative:
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Tourniquet may be used
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Tourniquet pain normally begins 45 minutes after inflation
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Tourniquet pain is unresponsive to analgesics
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Supine position with the affected arm extended on a hand table
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Duration 30-90 minutes
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EBL minimal
Postoperative:
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Splint is applied at the end of the case
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Pain management
Complications:
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Neurovascular compromise
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Hematoma
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Infection
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Local anesthetic toxicity
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Tendon/nerve laceration
Sources:
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.