Combined distal median nerve block and local anesthesia with lidocaine:epinephrine for carpal tunnel release

AIM: Evaluating patient comfort during full awake local anesthesia in carpal tunnel release surgery, without tourniquet use, by using epinephrine to obtain a completely dry surgical field. METHODS: We included into the study 41 patients who underwent carpal tunnel syndrome surgery under full awake combined anesthesia, using a 9-point questionnaire. Pain and anxiety in all patients were evaluated through a Wang-Baker 0–5 scale. The injection solution consisted of 0.1cc of epinephrine and 10cc of 1% lidocaine (1:100.000); 5cc were used for local cutaneous anesthesia, and 5cc were used for distal median nerve block. All patients underwent a classic, open carpal tunnel release. RESULTS: Anxiety scores during anesthesia and the post-operative period did not show a statistically significant difference (p > 0.01), with keeping their levels at low perception scores (average score of 1.68 ± 0.38 CI 95%, with a modal value of 2, compared to an average of 0.78 ± 0.29 CI 95% with a modal value of 0). Similar results were obtained for pain scores during anesthesia (1.73 ± 0.48 CI 95% with a most frequent modal score of 1). Our results also showed that the effects of combined anesthesia in carpal tunnel release surgery persisted well into the 6-hour post-operative moment, pain scores remaining low, statistically significant similar to recorded values during the anesthesia moment (p > 0.01), at an average of 2.29 ± 0.5 CI 95% with a modal value of 1. No serious complications were recorded. CONCLUSION: Combined distal median nerve block and local anesthesia with epinephrine:lidocaine provides a comfortable option for patients, with minimal risks of complications.