ECTR With Tourniquet and Local Anesthesia Only: Efficiency and Patient Satisfaction

Abstract

Background:

Carpal tunnel release (CTR) is commonly performed using wide-awake local anesthesia no tourniquet (WALANT) in a clinic or ambulatory surgery center and is shown to have similar satisfaction rates and postoperative complication profile compared to operating room (OR) procedures. Endoscopic carpal tunnel release (ECTR) is commonly performed; however, it is usually done in an OR setting with the use of anesthesia (OR-ECTR). We present a single institution’s experience performing ECTR utilizing a tourniquet under local only anesthesia (LO-ECTR). We compared procedural efficiency and environmental impact between OR-ECTR and LO-ECTR. In addition, patient satisfaction with LO-ECTR was assessed via a postprocedural survey.

Methods:

A retrospective review identified patients who underwent OR-ECTR and LO-ECTR from June 2021 to June 2023 by a single surgeon at our institution. Efficiency was measured by comparing procedure, recovery, and total time spent in the hospital. Environmental impact was assessed by measuring OR waste weight. Student’s t-tests for continuous variables and Chi-squared tests for categorical variables were performed. Patients in the LO-ECTR group answered a survey immediately postoperatively that included pain scores on a Likert scale and overall satisfaction. Inclusion criteria included primary carpal tunnel syndrome (CTS), diagnosis based on clinical or electromyography studies, and no concurrent procedures. The Microaire SmartRelease ECTR system was used in the OR-ECTR cases, and the Trice Seg-WAY ECTR-d system was used in the LO-ECTR cases.

Results:

A total of 137 cases in the LO-ECTR and 104 cases in the OR-ECTR group met inclusion criteria. Age, body mass index, operative hand, and race were similar between both groups. LO-ECTR procedures were faster than OR-ECTR procedures for all time metrics. Total procedure and operating time improved (9 ± 2 minutes vs 14 ± 4 minutes and 15 ± 2 minutes vs 28 ± 6 minutes). Preoperative holding time improved (35 ± 15 minutes vs 89 ± 30 minutes). Recovery time was notably faster (7 ± 4 minutes vs 48 ± 22 minutes), which affected total hospital time (61.9 ± 18.6 minutes vs 166.9 ± 38.3 minutes). All differences were statistically significant with P < .001. Waste weights were significantly lower in the LO-ECTR cohort than those in the OR-ECTR cohort; however, sample sizes were small in both cohorts (1.3 ± 0.04 kg in LO-ECTR vs 6.0 ± 0.7 kg in OR-ECTR, P < .001). Within the LO-ECTR group, the overall pain level experience was mild/moderate. The average overall satisfaction with the experience was 96.6%, with 98.5% of patients stating they would recommend this procedure to a friend.

Conclusion:

LO-ECTR was faster than OR-ECTR for all studied time metrics. Data are suggestive of improvement in the environmental impact factor. Limitations include a lack of meaningful postoperative patient events and retrospective nature of the study. Further studies will investigate long-term outcomes in the LO-ECTR group.