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AMBULATORY ANESTHESIA

Distal Nerve Blocks at the Wrist for Outpatient Carpal Tunnel Surgery Offer Intraoperative Cardiovascular Stability and Reduce Discharge Time

Department of Anesthesiology and International Regional Research Center, The University of Texas Medical School at Houston, Houston, Texas

Address correspondence and reprint requests to Jacques E. Chelly, MD, PhD, MBA, Department of Anesthesiology, University of Texas-Houston Medical School, 6431 Fannin MSB 5.020, Houston, TX 77030-1503. Address e-mail to Jacques.E.Chelly{at}uth.tmc.edu

Carpal tunnel release is often performed as an outpatient procedure. We designed this retrospective study to assess the effect of different anesthesia techniques on intraoperative cardiovascular stability and discharge time. According to the anesthesia technique received, 62 consecutive patients were categorized in Group BIER (IV regional anesthesia), Group BLOCK (distal nerve blocks), and Group GENERAL (general anesthesia). Incidences of intraoperative periods of tachycardia or bradycardia and hyper- or hypotension were studied, as were tourniquet, surgical, operating room, and discharge times. Cardiovascular stability was better achieved in Group BLOCK, as indicated by a significantly smaller incidence of periods of hypertension compared with Group BIER (5% vs 25%) and a significantly less frequent incidence of periods of hypotension compared with Group GENERAL (14% vs 42%). Patients in Group BLOCK spent significantly less time in the hospital after surgery than patients in Group BIER (65 vs 88 min) or patients in Group GENERAL (65 vs 133 min). We conclude that distal nerve blocks for outpatient carpal tunnel surgery are associated with greater intraoperative cardiovascular stability than general anesthesia. After surgery, patients in Group BLOCK could be discharged earlier than patients who received IV regional anesthesia or general anesthesia; this could be related to the superior postoperative analgesia provided by this technique.

IMPLICATIONS: This retrospective analysis of three different anesthetic techniques for ambulatory carpal tunnel surgery shows that nerve blocks performed at the wrist provided excellent intraoperative cardiovascular stability and allowed for earlier discharge.

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