THE EFFECT OF LOCAL ANAESTHETICS IN REHABILITATION AFTER OPEN CARPAL TUNNEL SURGERY

Abstract

Introduction: The aim of this study is to present the effect of various local anaesthetics, in particular solution concentrations, in peri- and post-operative analgesia in patients with carpal tunnel syndrome (CTS).

Material and Method: 105 patients with CTS (81 female, 24 male, ages 27–79) underwent carpal tunnel release under local anaesthesia. The patients were divided into 5 groups (xylocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, chirocaine 0.25%). A tablet of Gabapentin (Neurontin) 400mg was administered to some patients of each group (41 pts of the 105pts) 12 hours prior to surgery. All patients were evaluated immediately after surgery, in 2 weeks and 2 months postoperatively according to VAS pain score, grip strength, finger active motion and two point discrimination. Postoperative complications were also reported.

Results: Anesthesia was immediate after the local injection. All patients improved postoperativelly regarding relief from pain and paresthesias. There was no statistically significant difference in grip strength before and after surgery. Only 10 patients used paracetamol immediately after surgery, without any statistically significant correlation to any group of patients. 1 patient developed complex regional pain syndrome 2 months after surgery.

Conclusion: The use of local anaesthesia in carpal tunnel release surgery is beneficial in providing immediate intraoperative effect and recovery and mobilization after surgery. Rehabilitation seems to be irrelevant of the type of local anaesthetic that was used during the procedure. Small solution concentrations of local anaesthetics (ropivacaine 0.375%, chirocaine 0.25%) provide adequate analgesia during surgery and provide a normal postoperative course.