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A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial

100%
Żyluk A., Puchalski P., Walaszek I., Janowski P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
615-620
EN
Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia.The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression.Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixty-six patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre- intra- and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted.Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated short-time inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort.Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.
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Local Anesthesia in Thyroid Surgery - Own Experience and Literature Review

80%
Banasiewicz T., Meissner W., Pyda P., Wierzbicki T., Biczysko M., Głyda M., Iwanik K., Drews M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 5
264-270
EN
The local anesthesia in thyroid surgery is rarely used, only in selected patients. Majority of centers performing thyroid surgery with local anesthesia have possibility to convert to the general anesthesia.The aim of the study was to present our experiences with partial thyroidectomy under local anesthesia performed in 49 consecutive subjects in the Central African Republic (bilateral subtotal strumectomy, total resection of the one lobe, subtotal resection of the one lobe).Material and methods. All admitted patients with clinically significant goiter were accepted for surgical treatment. For infiltration anesthesia 1% lignocaine was used. Because of the shortage of medical resources, potential conversion to the general anesthesia was impossible. Before the operation patients had received an oral sedation and antibiotic. In 16 patients general anesthesia was used, in other 33 it was impossible.Results. Subtotal bilateral thyroidectomy was performed in 37 patients, 12 patients underwent lobectomy or partial lobectomy of the affected portion of the gland. There were no intraoperative and postoperative complications noticed in the reported group, including complications related to laryngeal nerve injury. The mean duration of the procedure was 127 minutes and mean medical follow-up was 3 days. General condition of all patients on the day of discharge from hospital was good.Conclusions. Surgery for goiter under local anesthesia may be a safe alternative where general anesthesia is not available or contraindicated for medical reasons. The infiltration anesthesia is simple to perform and reduces the number of complications potentially occurred at the C2-C4 neck plexus block.
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