BACKGROUND: Endoscopic carpal tunnel release (eCTR) is increasingly considered the procedure of choice by many surgeons to treat carpal tunnel syndrome. eCTR has several advantages over open carpal tunnel release due to its low complication and comorbidity rates. However, eCTR is standardly conducted under additional systemic anesthesia, which carries an independent risk of complications. An alternative is to perform the procedure under local anesthesia instead. This retrospective analysis presents the outcomes and complications of eCTR performed under local anesthesia.
METHODS: A retrospective review of patients who underwent eCTR with local anesthesia at a large tertiary center from 2015 to 2019 by a single fellowship-trained hand surgeon was performed. Patient demographic factors and comorbidities were recorded. The following intraoperative complications and postoperative outcomes were recorded: nerve laceration, surgical revision, infection, neuropraxia, wound dehiscence, and resolution of carpal tunnel syndrome symptoms.
RESULTS: One hundred eighty-three patients were identified to have received isolated eCTR with local anesthesia. Ninety-three (51%) procedures were performed on the right. Thirty-seven (20.2%) of patients were diabetic, and 40 (21.9%) patients reported tobacco use. A total of 168 patients (92%) reported resolution of preoperative carpal tunnel symptoms. Two (1.09%) patients required surgical revision. Six (3.3%) patients experienced infection. Two (1.09%) patients experienced neuropraxia and wound dehiscence. There were no nerve lacerations.
CONCLUSION: This study of a surgeon’s experience shows that eCTR can be performed safely under local anesthesia with low-complication rates and high rates of symptomatic resolution. Awake eCTR is a safe and effective route for patients who are at high risk for general anesthesia or prefer local anesthesia.