Carpal tunnel syndrome(CTS) is a common neuropathy, affecting the median nerve as it passes under the
transverse carpal ligament. CTS is described as a nerve compression at the
wrist plane, CTS causes numbness and tingling in the hand and fingers. Sir
James Paget defined CTS first in1853, and since then, in the 1950s a scientist
named George Phalen popularized the diagnosis and treatment of CTS. The
aetiology of CTS is considered idiopathic in most cases but it is still
controversial.
Conservative
treatment consists of splinting or corticosteroid injections and surgical
release of the carpal tunnel are the treatment method options. There has
been continued debate over the optimal management of this disease. Decision of
the surgeon has consistently varied.Carpal
tunnel release (CTR) is known as an effective treatment for idiopathic CTS. CTR
is performed with a variety of techniques such as endoscopic (ECTR) or open
(OCTR). Literature has not got consensus on the superiority of any one
technique to another.
Local
anaesthesia (LA) and general anaesthesia (GA) are anaesthetic options on the
surgical treatment of CTS. LA is safe, fast, and effective, but the injection
could be painful. In one recent series, about 10% of patients indicated
that they would prefer another form of anaesthesia. When applying the
local anaesthetics under the skin patient could have pain and pain could make
the patient uncomfortable. Also from the surgeon side discomfort of the patient
could affect the surgical procedure and sometimes visualization of the surgical
area could be difficult due to oedema caused by local anaesthetics. These
problems in surgical procedure could affect the clinical results of the
surgery. Sedation or GA could make the procedure more comfortable.
The aim of
the present study was to compare the effects of the anaesthetic methods on the
patient’s clinical results. To our knowledge this is the first report that
compares the clinical outcomes of the open CTR with GA or LA.Computerized patient
database was searched to identify all patients with CTS who underwent open CTR
between January 2009 and January 2013 at Fatih Sultan Mehmet Training and
Research Hospital. The year 2013 was selected to ensure a minimum one-year
follow-up. At the result of the search total of 148 patients (169 CTS hands)
were found. Of the 148
patients (169 CTS hands) 21 patients were operated bilaterally and excluded
from study. Of the 127 patient operated monolaterally. One patient died from
another reason and 14 patients was not available and excluded from the study.
Fifty five patients operated with GA (group A) and 57 patients with LA (group
B). The last available 50 monolateral patient operated by the same surgeon for
each group included to the study.
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