The use of local anesthesia in endoscopic release of the carpal tunnel

Objectives: We evaluated the early results of endoscopic carpal tunnel release with the use of local anesthesia. Methods: Endoscopic carpal tunnel release was performed in 14 hands of 10 patients (8 females, 2 males; mean age 43 years; range 35 to 58 years) using the two-portal Chow tech¬nique following local anesthesia described by Wood and Logan. Involvement was in the right hand in five patients, in the left in three, and in both hands in two patients. Electromyography showed moderate or severe compression of the median nerve in the carpal tunnel and the Tinelʹs and Phalenʹs signs were positive in all the patients. There was no previous history of metabolic diseases such as diabetes melli- tus, gout, or hypothyroidism, nor a coexisting pregnancy. The decision for surgery was given at the end of an unsuccessful conservative treatment for a month. The mean follow-up peri¬od was 16 months (range 10 to 24 months). Results: Two patients (14.3%) required further anesthesia with local anesthetic agents and sedation in the incision area. No complaints of paresthesia were seen during injections. Injection-associated problems such as increased thickness of the synovial layer or decreased endoscopic view did not occur. No instances of tendon or nerve injury, hematoma, or sympathetic dystrophy were seen. One patient developed neuropraxia in the third and forth fingers postoperatively. Early postoperative pain was observed in two wrists, appearing 10 days and two months after surgery, respectively. During the follow-up period, all the patients were free of preoperative com¬plaints and no recurrences were encountered. Conclusion: Local anesthesia is a rapid and reliable tech-nique in carpal tunnel surgery, enabling hospitalization confined to the same day.