Canadian Trends in Carpal Tunnel Surgery.

PURPOSE

Treatment patterns of carpal tunnel surgery by members of the American Society of Surgery of the Hand (ASSH) have recently been published. The majority of cases in this study were performed in the general operating room with intravenous (IV) sedation or a Bier block. Patients were most commonly prescribed hydrocodone for postoperative pain. The majority of carpal tunnel releases at our center are performed under local anesthesia alone, with plain acetaminophen (Tylenol) or codeine prescribed for postoperative pain. The authors were interested in determining whether these differences were specific to our center or whether there were nationwide differences among the Canadian Society of Plastic Surgery (CSPS) members compared to the ASSH members. We aimed to conduct a similar study to assess current trends across members of the CSPS to assess similarities and differences compared with current practices by members of the ASSH.

METHODS

A 10-question survey, modeled after a previously published study, was sent electronically to Canadian plastic surgeons (n = 400). A description and a link to the survey was sent via e-mail and data were anonymously submitted and analyzed using descriptive statistics.

RESULTS

The online survey was completed by 183 surgeons (46%). The local procedure room is used by 161 (surgeons 88%), whereas 15 surgeons (8%) used the general operating room. Subcutaneous local anesthetic is used by 98 surgeons (54%), a median nerve block by 68 (7%), a full wrist block used by 6 (3%), local anesthesia with IV sedation used by 6 (3%), a Bier block used by 3 (2%), and a general anesthetic used by 1 (0.5%). After surgery, 70 surgeons (38%) prescribed codeine, 49 (27%) prescribed plain paracetamol, 24 (13%) prescribed nonsteroidal anti-inflammatories, 21 (12%) prescribed tramadol, and 21 (12%) prescribed a narcotic stronger than codeine.

CONCLUSIONS

Compared with data obtained from ASSH members, differences in practice by Canadian plastic surgeons responding to this survey appear to be related to type of anesthetic used and postoperative analgesia provided. The majority of procedures in this study were performed in a local procedure room under local anesthetic alone and the majority of patients are discharged with codeine or paracetamol.

CLINICAL RELEVANCE

This study draws comparisons between Canadian plastic surgeons and members of the ASSH with respect to carpal tunnel surgery and adherence to the American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Diagnosis and Treatment of Carpal Tunnel Syndrome.