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The Patient's Perspective on Carpal Tunnel Surgery related to the Type of Anesthesia
Peter G. Davison, BSc, MD1; Tyson Cobb, MD1; Donald H. Lalonde, BSc, MSc, MD2
1Plastic Surgery, Dalhousie University, Saint John, NB, Canada; 2Plastic Surgery Dept, Dalhousie University, Saint John, NB, Canada

Background: Patients often have the impression that being “asleep” or “sedated” is the most comfortable and convenient method to have carpal tunnel surgery.  Wide awake carpal tunnel release, with only lidocaine and epinephrine injected locally in the area to be dissected (no tourniquet, no sedation, no intravenous, no monitoring), reduces the operation to a fancy dental procedure from an anesthetic point of view.  In our experience, patients who have been exposed to and understand this approach prefer its advantages - a single visit to the hospital (no preoperative testing), no nausea associated with sedation or general anesthesia, and no “hangover” from the sedation. The advantages of wide awake CTR performed with only local anesthesia must be counterbalanced by the concern that patients may poorly tolerate the procedure.   The purpose of this study is to capture the patient’s perspective of the wide awake technique following a CTR.

Methods: A patient questionnaire was designed and pilot tested.  This questionnaire was distributed to 83 consecutive patients at their first post-operative follow-up visit after a CTR, over a 6-month period.  All patients underwent a unilateral CTR using the wide awake technique.

Results: Of the 83 patients, the majority (94%) would prefer to have local anesthesia only for a subsequent CTR if they had to have the procedure over again.  No patients selected that they would prefer a general anesthetic and only 6% said they would prefer some IV sedation.  Compared to a routine dental procedure, 56% found that a wide awake CTR was less painful, 10% more painful, and 34% similar pain.  Patients’ anxiety, on a scale of 0-10, was rated as a mean of 2.2 ± 2.54 pre-operatively, 2.0 ± 2.34 during surgery, and 1.4 ± 1.88 post-operatively.

Discussion/Conclusion: Many surgeons feel that their patients would prefer being asleep or sedated for a CTR. Our results clearly demonstrate that the overwhelming majority of our patients who have actually had a wide awake CTR would prefer not to be asleep or sedated if they needed to have the surgery again. Most patients found the pain of the local anesthesia injection to be the same or better than dental procedures.  Patients who are offered and understand the wide awake approach prefer it to sedation or general anesthesia.

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