[The "wide-awake approach" - efficiency and patient safety in carpal tunnel releases]

In order to improve operating room efficiency in our institution, we introduced the wide-wake approach for carpal tunnel releases in 2012. This study examines the effect of this new anaesthetic technique on the work-flow and the duration of operation compared to the previously used axillary plexus anaesthesia.In this retrospective study, we reviewed the surgical case data of all patients in whom carpal tunnel releases had been performed as single procedures. 120 procedures of the year 2011, performed under axillary plexus anaesthesia, were compared to 153 procedures of the year 2012, performed as wide-awake surgery. We hypothesised that an earlier beginning of the first operation of the day with wide-awake surgery. Furthermore, we expected a shorter surgical time as well as a shorter interval between 2 carpal tunnel releases.By introduction of the wide-awake -approach, the first operation began a mean of 11 min earlier (p<0.001). While the surgical time did not change for the hand surgeon himself (10.7 vs. 10.2 min; p=0.478), the surgical time shortened significantly, when residents performed the operation (19.1 vs. 15.9 min, p<0.001). The interval between 2 carpal tunnel releases shortened from 19.8 to 17.7 min (p=0.009). Secure preparation was accomplished by the hypoperfused situs, when the wide-awake approach was applied, even though a tourniquet was not used. In the post-operative control, no complicated wound healings were noted.The wide-awake approach has proven to be reliable for the operating room -efficiency and, likewise, for patient safety. Therefore, we can recommend this technique without restrictions for carpal tunnel releases.