Karamanis Nikolaos, Stamatiou Georgia, Vasdeki Dionysia, Sakellaridis Nikolaos, Xarchas Konstantinos C, Varitimidis Sokratis, Dailiana Zoe H
Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece.
Department of Anesthesiology, Iaso Thessalias General Hospital, Larissa, Greece.
J Hand Microsurg. 2021 Apr;13(2):95-100. doi: 10.1055/s-0040-1709087. Epub 2020 Apr 9.
Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.
清醒状态下开放性腕管减压术是在局部麻醉下进行的一种手术。本研究旨在呈现不同局部麻醉药对接受该手术患者围手术期及术后镇痛的效果。
共有140例患者、150只手接受了局部麻醉下的腕管松解术。根据所使用的局部麻醉药，患者被分为五组：2%利多卡因组、0.75%罗哌卡因组、0.375%罗哌卡因组、0.5%左旋布比卡因组和0.25%左旋布比卡因组。每组各10例患者（共50例）在术前12小时给予总计400mg加巴喷丁。根据视觉模拟评分法（VAS）疼痛评分、握力和两点辨别觉，在术后即刻、2周和2个月对患者进行评估。
所有患者术后疼痛和感觉异常均显著改善，而加巴喷丁的使用并未影响结果。术后2个月握力恢复并超过术前值，各分组间无差异。未报告感染、血肿或再次手术病例。
开放性腕管松解术后的恢复情况似乎与手术过程中所使用的局部麻醉药类型无关。低浓度局部麻醉药溶液（2%利多卡因、0.375%罗哌卡因和0.25%左旋布比卡因）可提供充分的术中镇痛，且不影响术后进程。
