Contribution of ultrasound-assisted surgery coupled with Walant anaesthesia in bilateral carpal tunnel surgery.

INTRODUCTION

The simultaneous bilateral release of carpal tunnels still remains a non-unanimous practice. We prospectively studied the contribution of ultrasound-guided surgery coupled with Walant anaesthesia in the simultaneous release of both carpal tunnels.

MATERIALS AND METHODS

Patients who presented bilateral clinical involvement confirmed by electromyogram were operated on in the operating room under Walant anaesthesia by minimally invasive knife section under ultrasound guidance. The follow-up focused on pain immediately after local anaesthesia, when leaving the operating room, on day 1 and then on day 7. Satisfaction on day 0, day 7 and at 3 months, complications as well as the resumption of daily activities, light manual activities then heavy manual activities were reported.

RESULTS

10 patients were operated on. The median average pain score was less than 1 after anaesthesia, on day 0 in the immediate postoperative period on day 1 and on day 7. Mean satisfaction was above 9 ​at day 0, day 7 and month 3. There were 2 minor postoperative complications, one spontaneously resolved after 45 days, the other requiring additional intervention on another site of compression of the median nerve upstream. Resumption of light manual activities was 3 days and heavy manual activities 31 days.

DISCUSSION

The release of the bilateral carpal tunnel remains a rare surgical practice due to fear of pain and postoperative disability particularly during the initial postoperative period. However, the release of the carpal tunnel in ultrasound-guided surgery under Walant anaesthesia has proven painless and fast function recovery.

CONCLUSION

The release under Walant anaesthesia with ultrasound assistance of simultaneous bilateral carpal tunnel is safe for the patient. Patient satisfaction is high. We recommend this technique in selected patients.