Anesthetic management of median nerve decompression in patients with carpal tunnel syndrome
Keywords:carpal tunnel syndrome, multimodal perioperative pain relief
Background. Carpal tunnel syndrome (CTS) is the most common compression neuropathy. In patients with ineffective conservative treatment for severe forms, carpal tunnel release (CTR) is shown, which allows an improvement in more than 90 % of cases. In addition to adequate low-traumatic intervention tactics, optimal perioperative analgesia is also of great importance in restoring the function of the median nerve (correction of neuropathic disorders). The work was aimed to improve the results of treatment of patients with carpal tunnel syndrome by the adequate perioperative anesthetic provision of median nerve decompression. The objectives of the work were to propose a multimodal perioperative provision of median nerve decompression; to study the dynamics of pain syndrome; to evaluate the effectiveness of the proposed approach. Materials and methods. We examined 52 patients with CTS. The intervention was carried out under multimodal anesthesia — local anesthesia. At the beginning of the operation, a lidocaine solution was injected into the cavity of the carpal canal. Dexketoprofen was administered intramuscularly 20–30 minutes before the intervention; intravenous paracetamol. Intramuscular administration of dexketoprofen was repeated after 12 hours. The Boston BCTQ questionnaire was used to assess the recovery of hand function and the dynamics of neuropathic disorders in the groups with minimally invasive and open standard intervention. The dynamics of the pain syndrome intensity were measured by the values of the visual analogue scale (VAS) according to a 10-point assessment. Results. The dynamics of VAS indices indicated insignificant pain even in the group with an open, relatively traumatic, intervention. There was no significant difference between the indicators of the groups; pain syndrome during the intervention and the first 12 hours after it was assessed by the operated patients as mild pain. Additional anesthesia, especially opioid anesthetics, was not required. Within four weeks, the scores on the Boston BCTQ questionnaire had statistically insignificant differences, and in 3 and 6 months, they practically did not differ in the groups. At all stages of observation, no significant statistical differences were found between the groups. Conclusions. Conducted multimodal perioperative anesthesia in the proposed scope allowed achieving a good analgesic effect, approximating the results of neuropathic and functional rehabilitation in patients of different groups.
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