Single-center experience of cubital tunnel syndrome surgery performing transposition or internal neurolysis with external decompression under regional intravenous anesthesia technique

Year 2023, , 438 - 444, 27.10.2023

Ali Güler

https://doi.org/10.38053/acmj.1344313

Abstract

Aims: To share the 7-year experience of a single center in the application of regional intravenous anesthesia (RIVA) for surgical treatment of cubital tunnel syndrome (CTS) caused by compression of the ulnar nerve in the elbow region.
Methods: A total of 100 patients with CTS who were operated with the RIVA technique at a single center between 2012 and 2019 were retrospectively analyzed. In the RIVA technique, after providing venous drainage in the operated side arm, the double cuff tourniquet was inflated in the upper arm, and anesthesia was provided by administering a 30-40 mL solution of 2% lidocaine (3 mg/kg) diluted in 1% saline through the intravenous catheter. The surgical methods applied (transposition or internal neurolysis with external decompression), demographic data, preoperative and postoperative visual analog scale (VAS) scores for pain were compared.
Results: Out of 100 patients, 30 patients underwent surgical transposition (group 1) while internal neurolysis with external decompression was performed in 70 patients (group 2). The mean age of patients in groups 1 and 2 was 66.3±12.1 and 60.6±11.7 years, respectively. Women accounted for 73.3% of patients in group 1 and 87.1% of patients in group 2. The left side was affected in 18 (60%) patients in group 1 and 42 (60%) patients in group 2. In group 1, the mean postoperative 3rd-week VAS score (1.96±0.76) was significantly lower than the mean preoperative VAS score (7.46±0.93; p<0.001). Similarly, in group 2, the mean postoperative 3rd-week VAS score (1.84±0.62) was significantly lower than the mean preoperative VAS score (7.45±0.87; p<0.001). There was no significant between-group difference with respect to preoperative or postoperative 3rd-week VAS scores.
Conclusion: In the presence of technical infrastructure, the RIVA method can be preferred in the surgical treatment of CTS.

Keywords

Ulnar nerve, decompression, RIVA, VAS

Thanks

Acknowledgements: “Preparation for publication of this article is partly supported by Turkish Neurosurgical Society” English editing of this article was done by enago

Rejyonel intravenöz anestezi tekniği ile kübital tünel sendromu cerrahisinde tek merkez deneyimi

Abstract

Amaç: Ulnar sinirin dirsek bölgesinde sıkışması sonucu oluşan kübital tünel sendromunun (KTS) cerrahi tedavisinde rejyonel intravenöz anestezi (RIVA) uygulamasında tek merkezin 7 yıllık deneyimini paylaşmak.
Gereç ve yöntem: 2012-2019 yılları arasında tek merkezde RIVA tekniği ile opere edilen KTS'li toplam 100 hasta retrospektif olarak incelendi. RIVA tekniğinde ameliyatlı kolda venöz drenaj sağlandıktan sonra üst kolda çift manşonlu turnike şişirilerek %2'lik lidokain (3 mg/kg) solüsyonunda seyreltilmiş 30-40 mL'lik solüsyon verilerek anestezi sağlandı. İntravenöz kateter yoluyla %1 salin. Uygulanan cerrahi yöntemler (transpozisyon veya eksternal dekompresyon ile internal nöroliz), demografik veriler, preoperatif ve postoperatif ağrı için görsel analog skala (VAS) skorları karşılaştırıldı.
Bulgular: 100 hastanın 30'una cerrahi transpozisyon (grup 1), 70 hastaya (grup 2) eksternal dekompresyon ile internal nöroliz uygulandı. Grup 1 ve 2'deki hastaların yaş ortalaması sırasıyla 66,3±12,1 ve 60,6±11,7 idi. Grup 1'deki hastaların %73,3'ünü, grup 2'deki hastaların %87,1'ini kadınlar oluşturuyordu. Grup 1'de 18 (%60), grup 2'de 42 (%60) hastada sağ taraf etkilenmişti. Grup 1'de ortalama postoperatif 3. hafta VAS skoru (1,96±0,76), preoperatif ortalama VAS skorundan (7,46±0,93; p<0,001) anlamlı derecede düşüktü. Benzer şekilde grup 2'de ameliyat sonrası 3. hafta ortalama VAS skoru (1,84±0,62), ameliyat öncesi ortalama VAS skorundan (7,45±0,87; p<0,001) anlamlı derecede düşüktü. Ameliyat öncesi ve sonrası 3. hafta VAS skorları açısından gruplar arasında anlamlı fark yoktu.
Sonuç: KTS'nin cerrahi tedavisinde teknik alt yapı varlığında RIVA yöntemi tercih edilebilir.

Keywords

Ulnar sinir, dekompresyon, RİVA, VAS.

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