الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The study aimed to compare the outcomes of open carpal tunnel release performed under wide awake anesthesia versus general anesthesia which include measurement of physical function and symptoms in patients with each procedure using disability of Arm, Shoulder and Hand (QuickDASH) score, the effectiveness of each technique by intraoperative observation for field bleeding and pain assessment by visual analogue scale (VAS). Also, patient satisfaction and perspectives on the anesthesia experience with each procedure.
This prospective study was conducted on 40 adult patients with moderate to severe carpal tunnel syndrome. Patients were divided into two cohorts. There were 20 patients in the WALANT group (group A) and 20 patients in the general anesthesia group (group B). Patients ages were between 25-59 years at the time of presentation where the mean age in our study was 42 years. Thirty-nine patients were females and one was male. One patient was heavy manual worker (2.5%), three patients were light workers (7.5%) and thirty-six patients were house wives (90%). All patients included in this study were right handed. The duration of symptoms ranged from 8 to 25 months. In group (A), 6 patients were diabetic while in group (B), 5 patients were diabetic. All cases had received conservative treatment in the form of NSAIDs for at least 3 months with no improvement.
All the patients were evaluated preoperatively using QuickDASH. The mean QuickDASH score in group (A) was (39.60 ± 3.55) points. In group (B) the mean score was (40.50 ± 4.33) points. They were similar as regard severity of symptoms (p=0.414). Postoperatively, the patients experienced satisfactory alleviation of their symptoms which were reflected by the results obtained by the scores of QuickDASH in both groups. Two weeks post-operatively, in group (A) the mean score of QuickDASH score was (28.80 ±5.58); while in group (B), the mean score of QuickDASH score was (29.90 ± 5.23). Three months post-operatively, in group (A) the mean score of QuickDASH score was (16.85 ± 7.23); while in group (B), the mean score of QuickDASH score was (16.70 ± 3.45).
In our study as regard Visual analogue scale (VAS) during surgery and two weeks post-operatively, the difference of the means was statistically insignificant between both groups. But, immediate postoperative (VAS) scores at 2, 4 and 6 hours post-operative were significantly lower in the WALANT group.
The results of our study proved the advantage of epinephrine in minor hand procedures. In the WALANT group, the bleeding was minimal to moderate but the surgery was performable with better patient comfort by excluding tourniquet pain. While in the general anesthesia group, bleeding was controlled by tourniquet usage resulting in a bloodless operative field. However, after tourniquet release, there was vasodilatation leading to moderate bleeding.
At the end of the follow up period; patient satisfaction in both groups was 95%. In our study, in WALANT group 80% of patients preferred to be awake if they were to have the same surgery again and 20% preferred to be asleep; while GA group, 10% preferred to be awake and 90% preferred to be asleep. The difference between the two groups was statistically significant. The need for more anesthesia despite patient satisfaction may be caused by intraoperative anxiety or injection pain.