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Our Long-Term Experience in a Single Center for Carpal Tunnel Syndrome (CTS) Surgery Using the Regional Intravenous Anesthesia (RIVA/IRVA) Technique

Year 2023, Volume: 12 Issue: 3, 1447 - 1454, 26.09.2023

Ali Güler

Abstract

General anesthesia, subcutaneous local anesthesia and regional intravenous anesthesia (RIVA) are among the methods used in the surgical treatment of carpal tunnel syndrome (CTS), which is the most common peripheral nerve entrapment. The type of anesthesia used is the personal preference of the surgeon, and its various advantages over each other are still controversial. In this study, the long-term experience of a single center that performed CTS surgery with the RIVA method was discussed. In this study, it was aimed to evaluate the effect of RIVA method on postoperative pain in CTS surgery. Patients who underwent unilateral CTS surgery with the RIVA method between 2010 and 2019 were retrospectively scanned and included in our study. In the study in which 520 patients were included, the pain symptoms of the patients were evaluated with preoperative and postoperative 3rd week visual pain scale (VAS) values. In addition, demographic data and accompanying comorbidities were also evaluated.

Keywords

Carpal tunnel RIVA VAS

References

  • 1. Diao E. (2017). ‘’Carpal Tunnel Syndrome and Related Median Neuropathies: Clinical Presentations and Diagnosis’’,31-38.
  • 2. Alfonso C, Jann S, Massa R, Torreggiani A. (2010). ‘’Diagnosis, treatment and follow-up of the carpal tunnel synrome: a review’’. Neurol Sci, 31(3):243-252. doi: 10.1007/s10072-009- 0213-9. Epub 2010 Feb 10.
  • 3. Graham B, Peljovich AE, Afra R, Cho MS, Gray R et al. (2016). ‘’The American Academy of Orthopaedic Surgeons Evi-denceBased Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome’’. J Bone Joint Surg Am, 19;98(20):1750- 1754. doi: 10.2106/JBJS.16.00719.
  • 4. Seror P. (1988). ‘’Phalen’s test in the diagnosis of carpal tunnel syndrome’’. J Hand Surg Br, 13(4):383-5. doi: 10.1016/0266- 7681_88_90160-x.
  • 5. De Smet L. (2003). ‘’Value of some clinical provocative tests in carpal tunnel syndrome: Do we need electrophysiology and can we predict the outcome?’’. Hand Clin, 19(3):380- 91. doi: 10.1016/s0749-0712(02)00129-4.
  • 6. Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, et al. (2002). ‘’An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome’’. Clin Neurophysiol, 113(9):1429–34. doi: 10.1016/s1388- 2457(02)00201-8.
  • 7. Padua L, Cuccagna C, Giovannini S, Coraci D, Pelosi L, Loreti C, Bernabei R, Hobson-Webb LD. (2023). ‘’Carpal tunnel syndrome: updated evidence and new questions’’. Lancet Neurol, 22(3):255-267. doi: 10.1016/S1474-4422(22)00432-X.
  • 8. Learmonth JR. (1933). ‘’The principle of decompression in the treatment of certain diseases of peripheral nerves’’. Surg Clin North Am, 13:905–13.
  • 9. Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. (2006). ‘’Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial’’. BMJ, 332:1473. doi: 10.1136/bmj.38863.632789.1F.
  • 10. Keser N, Dortcan N, Cikla U, Uluc K, Celikoglu E, Is M, Gurer B. (2017). ‘’Semivertical incision: An aesthetically and electrophysiologically effective mini-incision technique for carpal tunnel decompression’’. Med Sci Monit, 23:2993-3000. doi: 10.12659/msm.902343.
  • 11. Bal E, Piskin A, Ada S, Ademoglu Y, Toros T, Kayalar M. (2008). ‘’Comparison between two mini incision techniques utili-zed in carpal tunnel release’’. Acta Orthop Traumatol Turc, 42(4):234- 237. doi: 10.3944/aott.2008.234.
  • 12. Palmer AK, Toivonen DA. (1999). ‘’Complications of endoscopic and open carpal tunnel release’’. J Hand Surg (Am), 24:561-5. doi: 10.1053/jhsu.1999.0561.
  • 13. Munns JJ, Awan HM. (2015). ‘’Trends in carpal tunnel surgery: an online survey of members of the American Society for Surgery of the Hand’’. J Hand Surg Am, 40(4):767–71.e2. doi: 10.1016/j.jhsa.2014.12.046.
  • 14. Bier A. (1908). ‘’Über einen neuen Weg, Lokalanästhesie an den Gliedmans sen zu erzeugen’’. Arch Klin Chir, 86:1007–16.
  • 15. Holmes CM. (1963). ‘’Intraveneus regional ana lgesia. A useful method of producing analgesia of thelimbs’’. Lancet, 2;1:245-7.
  • 16. Okten F, Cakar T, Leblebici KS. (2013). ‘’Lokal anestezikler. In: Guldogus F, Gurkan Y, (ed). Rejyonal Anestezi. 1st ed. Is-tanbul / Turkey’’. Nobel Tip Kitabevi, p. 79–89.
  • 17. Flamer D, Peng PWH. (2011). ‘’Intravenous Regional Anesthesia: A review of comman local anesthetic optins and the use of opioids and muscle relaxants as adjuncts’’. Local Reg Anesth, 4: 57-76. doi: 10.2147/LRA.S16683.
  • 18. Foster BD, Sivasundaram L, Heckmann N, et al. (2017). ‘’Surgical approach and anesthetic modality for carpal tunnel release: A nationwide database study with health care cost implications’’. Hand (N Y), 12:162–167. doi: 10.1177/1558944716643276.
  • 19. Peters B, Giuffre JL. (2018). ‘’Canadian trends in carpal tunnel surgery’’. J Hand Surg Am, 43:1035.e1–1035.e8. doi: 10.1016/j.jhsa.2018.02.014.
  • 20. Okamura A, Guidetti BC, Caselli R, Borracini JA, Moraes VY, Belloti JC. (2018). ‘’How do board-certified hand surgeons manage carpal tunnel syndrome? A national survey’’. Acta Ortop Bras, 26:48–53. doi: 10.1590/1413-785220182601181880.
  • 21. Ayhan E, Akaslan F. (2020). ‘’Patients' Perspective on Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia’’. Plast Reconstr Surg, 145(5):1197-1203. doi: 10.1097/PRS.0000000000006741.
  • 22. Okamura A, Moraes VY, Fernandes M, Raduan-Neto J, Belloti JC. (2021). ‘’WALANT versus intravenous regional anes-thesia for carpal tunnel syndrome: a randomized c linical trial’’.Sao Paulo Med J, 139(6):576-578. doi: 10.1590/1516 3180.2020.0583.R2.0904221. eCollection 2021.
  • 23. Nabhan A, Steudel WI, Dedeman L, Al-Khayat J, Ishak B. (2011). ‘’Subcutaneous local anesthesia versus intravenous regional anesthesia for endoscopic carpal tunnel release: a randomized controlled trial’’. J Neurosurg, 114(1):240-4. doi: 10.3171/2008.2.17395.
  • 24. Sørensen AM, Dalsgaard J, Hansen TB. (2013). ‘’Local anaesthesia versus intravenous regional anaesthesia in endoscopic carpal tunnel release: a randomized controlled trial’’. J Hand Surg Eur Vol, 38(5):481-4. doi: 10.1177/1753193412453664.
  • 25. Jalil H, Polfliet F, Nijs K, Bruckers L, De Wachter G, Callebaut I, Salimans L, Van de Velde M, Stessel B. (2021). ‘’Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial’’. PLoS One, 19;16(2):e0246863. doi: 10.1371/journal.pone.0246863. eCollection 2021.
  • 26. Tomaino MM, Ulizio D, Vogt MT. (2001). ‘’Carpal tunnel release under intravenous regional or local anesthesia’’. J Hand Surg Br, 26(1):67-8. doi: 10.1054/jhsb.2000.0426.
  • 27. Vaughn N, Rajan N, Darowish M. (2020). ‘’Intravenous Regional Anesthesia Using a Forearm Tourniquet: A Safe and Ef-fective Technique for Outpatient Hand Procedures’’. Hand (N Y), 15(3):353-359. doi: 10.1177/1558944718812190.
  • 28. Mariano ER, Lehr MK, Loland VJ, Bishop ML. (2013). ‘’Choice of loco-regional anesthetic technique affects operating room efficiency for carpal tunnel release’'. J Anesth, 27(4):611-4. doi: 10.1007/s00540-013-1578-8.
  • 29. Peters B, Giuffre JL. (2018). ‘’Canadian Trends in Carpal Tunnel Surgery’’. J Hand Surg Am, 43(11):1035.e1-1035.e8. doi: 10.1016/j.jhsa.2018.02.014.
  • 30. Gurich RW Jr, Langan JW, Teasdall RJ, Tanner SL, Sanders JL. (2018). ‘’Tourniquet Deflation Prior to 20 Minutes in Upper Extremity Intravenous Regional Anesthesia’’. Hand (N Y), 13(2):223-227. doi: 10.1177/1558944716686214.
  • 31. Volkmar AJ, Day MA, Fleury IG, Lawler EA, Seering M, Caldwell LS. (2021). ‘’Safety and Efficacy of Forearm Tourniquet Compared to Upper Arm Tourniquet for Local Intravenous Regional Anesthesia in Hand Surgery: A Randomized Clinical Trial’’. Iowa Orthop J, 41(1):177-181.

Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz

Year 2023, Volume: 12 Issue: 3, 1447 - 1454, 26.09.2023

Ali Güler

Abstract

En sık görülen periferik sinir tuzaklanması olan karpal tünel senromu(KTS) cerrahi tedavisinde kullanılan yöntemler arasında genel anestezi, subkütan lokal anestezi ve rejyonel intravenöz anestezi(RİVA) yer almaktadır. Kullanılan anestezi şekli cerrahın kişisel tercihi olup birbirlerine çeşitli üstünlükleri halen tartışmalıdır. Bu çalışmada RİVA yöntemi ile KTS cerrahisi yapılan tek bir merkezin uzun dönem tecrübesi ele alınmıştır. Bu çalışmada KTS cerrahisinde RİVA yönteminin cerrahi sonrası ağrı üzerine etkisi değerlendirilmek amaçlanmıştır. Çalışmamıza 2010-2019 yılları arasında RİVA yöntemi ile tek taraflı KTS cerrahisi uygulanan hastalar retrospektif olarak taranarak dahil edilmiştir. 520 hastanın dahil edildiği çalışmada hastaların ağrı semptomları pre operatif ve post operatif 3. hafta vizüel ağrı skalası (VAS) değerleri ile değerlendirilmiştir. Ayrıca demografik verileri, eşlik eden komorbitide oluşturacak hastalıkları da değerlendirilmiştir.

Keywords

Karpal tünel sendromu RİVA VAS

References

  • 1. Diao E. (2017). ‘’Carpal Tunnel Syndrome and Related Median Neuropathies: Clinical Presentations and Diagnosis’’,31-38.
  • 2. Alfonso C, Jann S, Massa R, Torreggiani A. (2010). ‘’Diagnosis, treatment and follow-up of the carpal tunnel synrome: a review’’. Neurol Sci, 31(3):243-252. doi: 10.1007/s10072-009- 0213-9. Epub 2010 Feb 10.
  • 3. Graham B, Peljovich AE, Afra R, Cho MS, Gray R et al. (2016). ‘’The American Academy of Orthopaedic Surgeons Evi-denceBased Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome’’. J Bone Joint Surg Am, 19;98(20):1750- 1754. doi: 10.2106/JBJS.16.00719.
  • 4. Seror P. (1988). ‘’Phalen’s test in the diagnosis of carpal tunnel syndrome’’. J Hand Surg Br, 13(4):383-5. doi: 10.1016/0266- 7681_88_90160-x.
  • 5. De Smet L. (2003). ‘’Value of some clinical provocative tests in carpal tunnel syndrome: Do we need electrophysiology and can we predict the outcome?’’. Hand Clin, 19(3):380- 91. doi: 10.1016/s0749-0712(02)00129-4.
  • 6. Becker J, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, et al. (2002). ‘’An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome’’. Clin Neurophysiol, 113(9):1429–34. doi: 10.1016/s1388- 2457(02)00201-8.
  • 7. Padua L, Cuccagna C, Giovannini S, Coraci D, Pelosi L, Loreti C, Bernabei R, Hobson-Webb LD. (2023). ‘’Carpal tunnel syndrome: updated evidence and new questions’’. Lancet Neurol, 22(3):255-267. doi: 10.1016/S1474-4422(22)00432-X.
  • 8. Learmonth JR. (1933). ‘’The principle of decompression in the treatment of certain diseases of peripheral nerves’’. Surg Clin North Am, 13:905–13.
  • 9. Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. (2006). ‘’Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial’’. BMJ, 332:1473. doi: 10.1136/bmj.38863.632789.1F.
  • 10. Keser N, Dortcan N, Cikla U, Uluc K, Celikoglu E, Is M, Gurer B. (2017). ‘’Semivertical incision: An aesthetically and electrophysiologically effective mini-incision technique for carpal tunnel decompression’’. Med Sci Monit, 23:2993-3000. doi: 10.12659/msm.902343.
  • 11. Bal E, Piskin A, Ada S, Ademoglu Y, Toros T, Kayalar M. (2008). ‘’Comparison between two mini incision techniques utili-zed in carpal tunnel release’’. Acta Orthop Traumatol Turc, 42(4):234- 237. doi: 10.3944/aott.2008.234.
  • 12. Palmer AK, Toivonen DA. (1999). ‘’Complications of endoscopic and open carpal tunnel release’’. J Hand Surg (Am), 24:561-5. doi: 10.1053/jhsu.1999.0561.
  • 13. Munns JJ, Awan HM. (2015). ‘’Trends in carpal tunnel surgery: an online survey of members of the American Society for Surgery of the Hand’’. J Hand Surg Am, 40(4):767–71.e2. doi: 10.1016/j.jhsa.2014.12.046.
  • 14. Bier A. (1908). ‘’Über einen neuen Weg, Lokalanästhesie an den Gliedmans sen zu erzeugen’’. Arch Klin Chir, 86:1007–16.
  • 15. Holmes CM. (1963). ‘’Intraveneus regional ana lgesia. A useful method of producing analgesia of thelimbs’’. Lancet, 2;1:245-7.
  • 16. Okten F, Cakar T, Leblebici KS. (2013). ‘’Lokal anestezikler. In: Guldogus F, Gurkan Y, (ed). Rejyonal Anestezi. 1st ed. Is-tanbul / Turkey’’. Nobel Tip Kitabevi, p. 79–89.
  • 17. Flamer D, Peng PWH. (2011). ‘’Intravenous Regional Anesthesia: A review of comman local anesthetic optins and the use of opioids and muscle relaxants as adjuncts’’. Local Reg Anesth, 4: 57-76. doi: 10.2147/LRA.S16683.
  • 18. Foster BD, Sivasundaram L, Heckmann N, et al. (2017). ‘’Surgical approach and anesthetic modality for carpal tunnel release: A nationwide database study with health care cost implications’’. Hand (N Y), 12:162–167. doi: 10.1177/1558944716643276.
  • 19. Peters B, Giuffre JL. (2018). ‘’Canadian trends in carpal tunnel surgery’’. J Hand Surg Am, 43:1035.e1–1035.e8. doi: 10.1016/j.jhsa.2018.02.014.
  • 20. Okamura A, Guidetti BC, Caselli R, Borracini JA, Moraes VY, Belloti JC. (2018). ‘’How do board-certified hand surgeons manage carpal tunnel syndrome? A national survey’’. Acta Ortop Bras, 26:48–53. doi: 10.1590/1413-785220182601181880.
  • 21. Ayhan E, Akaslan F. (2020). ‘’Patients' Perspective on Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia’’. Plast Reconstr Surg, 145(5):1197-1203. doi: 10.1097/PRS.0000000000006741.
  • 22. Okamura A, Moraes VY, Fernandes M, Raduan-Neto J, Belloti JC. (2021). ‘’WALANT versus intravenous regional anes-thesia for carpal tunnel syndrome: a randomized c linical trial’’.Sao Paulo Med J, 139(6):576-578. doi: 10.1590/1516 3180.2020.0583.R2.0904221. eCollection 2021.
  • 23. Nabhan A, Steudel WI, Dedeman L, Al-Khayat J, Ishak B. (2011). ‘’Subcutaneous local anesthesia versus intravenous regional anesthesia for endoscopic carpal tunnel release: a randomized controlled trial’’. J Neurosurg, 114(1):240-4. doi: 10.3171/2008.2.17395.
  • 24. Sørensen AM, Dalsgaard J, Hansen TB. (2013). ‘’Local anaesthesia versus intravenous regional anaesthesia in endoscopic carpal tunnel release: a randomized controlled trial’’. J Hand Surg Eur Vol, 38(5):481-4. doi: 10.1177/1753193412453664.
  • 25. Jalil H, Polfliet F, Nijs K, Bruckers L, De Wachter G, Callebaut I, Salimans L, Van de Velde M, Stessel B. (2021). ‘’Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial’’. PLoS One, 19;16(2):e0246863. doi: 10.1371/journal.pone.0246863. eCollection 2021.
  • 26. Tomaino MM, Ulizio D, Vogt MT. (2001). ‘’Carpal tunnel release under intravenous regional or local anesthesia’’. J Hand Surg Br, 26(1):67-8. doi: 10.1054/jhsb.2000.0426.
  • 27. Vaughn N, Rajan N, Darowish M. (2020). ‘’Intravenous Regional Anesthesia Using a Forearm Tourniquet: A Safe and Ef-fective Technique for Outpatient Hand Procedures’’. Hand (N Y), 15(3):353-359. doi: 10.1177/1558944718812190.
  • 28. Mariano ER, Lehr MK, Loland VJ, Bishop ML. (2013). ‘’Choice of loco-regional anesthetic technique affects operating room efficiency for carpal tunnel release’'. J Anesth, 27(4):611-4. doi: 10.1007/s00540-013-1578-8.
  • 29. Peters B, Giuffre JL. (2018). ‘’Canadian Trends in Carpal Tunnel Surgery’’. J Hand Surg Am, 43(11):1035.e1-1035.e8. doi: 10.1016/j.jhsa.2018.02.014.
  • 30. Gurich RW Jr, Langan JW, Teasdall RJ, Tanner SL, Sanders JL. (2018). ‘’Tourniquet Deflation Prior to 20 Minutes in Upper Extremity Intravenous Regional Anesthesia’’. Hand (N Y), 13(2):223-227. doi: 10.1177/1558944716686214.
  • 31. Volkmar AJ, Day MA, Fleury IG, Lawler EA, Seering M, Caldwell LS. (2021). ‘’Safety and Efficacy of Forearm Tourniquet Compared to Upper Arm Tourniquet for Local Intravenous Regional Anesthesia in Hand Surgery: A Randomized Clinical Trial’’. Iowa Orthop J, 41(1):177-181.
There are 31 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Article
Authors

Ali Güler 0000-0002-8926-0313

Publication Date September 26, 2023
Published in Issue Year 2023 Volume: 12 Issue: 3

Cite

APA Güler, A. (2023). Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 12(3), 1447-1454. https://doi.org/10.37989/gumussagbil.1271092
AMA Güler A. Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. September 2023;12(3):1447-1454. doi:10.37989/gumussagbil.1271092
Chicago Güler, Ali. “Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12, no. 3 (September 2023): 1447-54. https://doi.org/10.37989/gumussagbil.1271092.
EndNote Güler A (September 1, 2023) Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12 3 1447–1454.
IEEE A. Güler, “Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz”, Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 3, pp. 1447–1454, 2023, doi: 10.37989/gumussagbil.1271092.
ISNAD Güler, Ali. “Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12/3 (September 2023), 1447-1454. https://doi.org/10.37989/gumussagbil.1271092.
JAMA Güler A. Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12:1447–1454.
MLA Güler, Ali. “Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 3, 2023, pp. 1447-54, doi:10.37989/gumussagbil.1271092.
Vancouver Güler A. Rejyonel İntravenöz Anestezi (RİVA/IRVA) Tekniği Kullanılarak Karpal Tünel Sendromu (KTS) Cerrahisi Yapılan Tek Bir Merkezde Uzun Dönem Tecrübemiz. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12(3):1447-54.
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