Surgical Treatment of Carpal Tunnel Syndrome: Local Anesthesia With Epinephrine x Intravenous Regional Anesthesia.
Carpal Tunnel Syndrome, Anesthesia
About this trial
This is an interventional health services research trial for Carpal Tunnel Syndrome
Eligibility Criteria
Inclusion Criteria:
- Patients older than 18 years of age, with idiopathic Carpal Tunnel Syndrome with indication for surgery due to failure of conservative treatment for at least three months or that presented at the initial diagnosis with motor impairment detected by clinical examination (hypotrophy) and/or by electromyography (ENMG) examination.
- The diagnosis of CTS will be made through the clinical evaluation in which CTS patients will be considered, those who present at least four of the clinical criteria proposed and proven by the electromyography examination.
Clinical Criteria for CTS - (At least 4 criteria will be required for clinical confirmation of the diagnosis)
- Paresthesia in the territory of the median nerve
- Night paresthesia of the hand
- Decreased strength with hypotrophy of the musculature tenar
- Positive tinnitus sign on the wrist
- Positive Phalen test
Loss of 2-point discrimination in the region innervated by the median nerve
- Patients who agree to participate, after having been adequately informed about the nature of the study, and have reading and signed the informed consent form.
Exclusion Criteria:
- Patients with prior history of cervical spine diseases (radiculopathies, arthrosis),
- Pregnant women and puerperal women,
- Patients with sequelae of previous wrist and hand surgeries,
- Other upper limb compressive syndromes and scapular girdles will be excluded
Sites / Locations
- Aldo Okamura
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Intravenous regional anesthesia (Bier)
Local anesthesia with adrenaline
The anesthetic technique described by Bier will be done by the anesthesiologist. The following steps were followed: 1)Placement double tourniquet on the proximal portion of the arm 2)Asepsis and antisepsis of the operative limb 3)Puncture and venous catheterization most distal in the limb 4)Elevation of limb for 1 to 2 minutes, next the limb will be spirally wrapped with Esmarch from the distal to proximal 5)The proximal cuff will be inflated 6)Withdrawal of Esmarch and injection of 40ml of lidocaine without epinephrine at 0.5% 7)Removal the canula until the distal cuff is inflated and the proximal cuff is emptied 8)Removal of the club must be done after the surgery, at least 40 minutes after the injection of the anesthetic.
Patients will be anesthetized by surgeons, who are familiar with the technique described by Lalonde. Around thirty minutes before surgery, will be infused with 20 ml of an anesthetic solution. The infiltrated solution is composed of 1% lidocaine with epinephrine in 1: 100,000. Initially 10 mL of the solution will be applied slowly in the flexion fold region of the wrist just below the skin and subfascial plane. The needle is moved slowly. The needle is then redirected to the radial side of the proximal palmar region for infiltration of another 2-3 mL of the subcutaneous solution. The remaining 7-8mL in the subdermal plane and anterior to the transverse carpal ligament.