PERSONNEL: Carpal Tunnel Release Under Local Infiltration Anaesthesia Versus Local Infiltration Anaesthesia and Median Nerve Block
Study Details
Study Description
Brief Summary
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. Treatment options include both non-operative and surgical methods. Surgical treatment, carpal tunnel release (CTR), involves division of the transverse carpal ligament. Surgery can be done under, local, axillary- or intravenous block or general anaesthesia. There are no randomised controlled trials (RCT), comparing local infiltration anaesthesia to local infiltration anaesthesia augmented with distal median nerve block in CTR.
The investigators' aim is to find out if distal median nerve block in adjunct to WALANT surgery reduces pain during CTR and postoperatively. The investigators' primary hypothesis is that distal median nerve block, in adjunct to local infiltration anaesthesia does not reduce pain during and after CTR compared to pure local anaesthesia.
The study is a blinded randomized controlled trial in patients with CTR. Patients will be randomly divided into two study groups. CTR is performed under WALANT. The first group will have local infiltration anaesthesia and distal median nerve block and the other local infiltration anaesthesia. The primary outcome measure is the pain level perceived by patient during the procedure using the visual analogue scale (VAS).
CTR is the most common hand surgical procedure, which is well suited for WALANT. The optimal method of local anaesthesia is however not clear. Possible advantages or disadvantages of median nerve blockade in adjunct to local infiltration anaesthesia can be assessed by a high-quality RCT.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Other: Local infiltration anaesthesia The investigators allocate 59 patients in this arm. It serves as the control group, who receives local infiltration anaesthesia. |
Procedure: Local infiltration anaesthesia
The anaesthetic cocktail consists of 4,5 ml of lidocaine with adrenalin 1%, 4,5 ml of bupivacaine with adrenalin 0.5% and 1 ml of (7.5%) sodium bicarbonate. The investigators use a 24 gauge hypodermic needle to inject the solution.
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Experimental: Local infiltration anaesthesia and distal median nerve block The investigators allocate 59 patients in this arm. It serves as the experimental group, who receives local infiltration anaesthesia and distal median nerve block. |
Procedure: Distal median nerve block and local infiltration anaesthesia
Local infiltration anaesthesia: The anaesthetic cocktail consists of 4,5 ml of lidocaine with adrenalin 1%, 4,5 ml of bupivacaine with adrenalin 0.5% and 1 ml of (7.5%) sodium bicarbonate. The investigators use a 24 gauge hypodermic needle to inject the solution.
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Outcome Measures
Primary Outcome Measures
- Pain level during the procedure with visual analogic scale (VAS) [Visual analogic scale is recorded immediately after the procedure]
The investigators evaluate the pain level perceived by patient during the procedure using visual analogic scale. The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable.
Secondary Outcome Measures
- Pain sensitivity using PCS-FINv2.0 form [Preoperatively]
The investigators evaluate pain sensitivity between patients using PCS-FINv2.0 form. The investigators ask patients to fill pain catastrophizing tendency evaluating form before the surgery in order to evaluate the pain levels between the experimental and control group.
- Expected pain level using visual analogic scale (VAS) [Preoperatively]
The difference between the expected pain using visual analogic scale (VAS). The investigators ask the patients to evaluate the pain they expect to experience during procedure. The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable.
- Duration of anaesthesia [Every 4 hours while awake after the surgery until 3rd postoperative night.]
The investigators assess the length of the anaesthesia by recording the pain level with visual analog scale (VAS) every 4 hours while awake. The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable.
- Patients' symptom severity and overall functional status [Before and 3 months after the surgery]
The investigators ask the patients to evaluate their symptoms using Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score. It consists of the Symptom Severity Scale (SSS) containing 11 questions, and it uses a five-point Likert rating scale from 1 (no symptoms) to 5 (most severe symptoms), and Functional Status Scale (FSS), which has 8 questions assessing the degree of complaints on a five-point Likert scale from 1 (no symptoms) to 5 (most severe symptoms). Mean sum scores of both scales are calculated and used for analysis.
- Consumption of pain killers [After the surgery until 3rd postoperative night]
The investigators record the consumption of pain killers after surgery
- Patient satisfaction [3 months after the surgery]
Patients evaluate how likely they would recommend the procedure to the fellowman using Net Promoter Score (NPS). Net Promoter Score is a measurement taken from asking patients how likely they are to recommend the procedure to others on a scale of 0-10. The higher score the better outcome.
- Number of experienced needle stings [Immediately after the injection of local anaesthetic.]
The investigators ask the patient to report how many needle stings they felt when the investigators performed the anaesthesia
- Pain caused by needle sting-, tension- and burning [Postoperatively, immediately after the procedure]
The investigators record pain perceived during the injection of the anaesthetic solution caused by needle sting-, tension- and burning using VAS
Eligibility Criteria
Criteria
Inclusion Criteria:
- Over 17 years of age with CTS verified by nerve conduction studies
Exclusion Criteria:
- Patients under 18 years, previous or recurrent carpal tunnel syndrome, repeat surgery, peripheral neuropathies like cervical radiculopathy and cubital tunnel syndrome, known allergy to the trial drugs, profound cognitive impairment, and pregnancy
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Kuopio University hospital, Department of Orthopaedics, Traumatology and Hand Surgery | Kuopio | Pohjois-Savo | Finland | 70210 |
Sponsors and Collaborators
- Kuopio University Hospital
- University of Eastern Finland
Investigators
- Study Director: Yrjänä Nietosvaara, Prof., Kuopio University Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
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- Pourmemari MH, Shiri R. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med. 2016 Jan;33(1):10-6. doi: 10.1111/dme.12855. Epub 2015 Aug 18. Review.
- Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res. 2011 Apr 11;6:17. doi: 10.1186/1749-799X-6-17. Review.
- Shiri R, Pourmemari MH, Falah-Hassani K, Viikari-Juntura E. The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies. Obes Rev. 2015 Dec;16(12):1094-104. doi: 10.1111/obr.12324. Epub 2015 Sep 23. Review.
- Shiri R. Hypothyroidism and carpal tunnel syndrome: a meta-analysis. Muscle Nerve. 2014 Dec;50(6):879-83. doi: 10.1002/mus.24453. Epub 2014 Oct 30.
- Stepić N, Novaković M, Martić V, Perić D. Effects of perineural steroid injections on median nerve conduction during the carpal tunnel release. Vojnosanit Pregl. 2008 Nov;65(11):825-9.
- Turner A, Kimble F, Gulyás K, Ball J. Can the outcome of open carpal tunnel release be predicted?: a review of the literature. ANZ J Surg. 2010 Jan;80(1-2):50-4. doi: 10.1111/j.1445-2197.2009.05175.x. Review.
- Wang L. Guiding Treatment for Carpal Tunnel Syndrome. Phys Med Rehabil Clin N Am. 2018 Nov;29(4):751-760. doi: 10.1016/j.pmr.2018.06.009. Epub 2018 Sep 17. Review.
- Wipperman J, Goerl K. Carpal Tunnel Syndrome: Diagnosis and Management. Am Fam Physician. 2016 Dec 15;94(12):993-999. Review.
- KUH5203140