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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
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Metacarpal Small Incision for Carpal Tunnel Syndrome
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Open carpal release using local anesthesia without a tourniquet: Does bleeding tendency affect the outcome?

Seongwon Lee1, Sangho Oh2, Daegu Son1

  • 1Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Korea.

Archives of Plastic Surgery
|November 25, 2020
PubMed
Summary

Minimal single palmar incision carpal tunnel release without a tourniquet is effective. This carpal tunnel surgery offers significant symptom improvement, especially for patients with bleeding tendencies.

Keywords:
Carpal tunnel syndromeHandMedian nerveNerve compression syndromeTourniquet

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Minimally Invasive Procedures

Background:

  • Carpal tunnel syndrome (CTS) is a common condition requiring surgical intervention.
  • Traditional carpal tunnel release often involves a tourniquet, which can cause discomfort.
  • Evaluating alternative techniques is crucial for improving patient outcomes and comfort.

Purpose of the Study:

  • To assess the clinical efficacy of minimal single palmar-incision carpal tunnel release.
  • To evaluate the outcomes of this technique performed without a tourniquet.
  • To determine the safety and effectiveness in patients with bleeding tendencies.

Main Methods:

  • Retrospective review of 75 patients (90 CTS cases) undergoing the procedure.
  • Comparison of pre- and post-operative Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores.
  • Analysis of outcomes and complications, stratified by bleeding tendency.

Main Results:

  • Complete symptom resolution or marked improvement observed in all cases within 6 months.
  • Significant improvement in postoperative BCTQ scores compared to preoperative scores.
  • No significant difference in outcomes based on the presence of a bleeding tendency.

Conclusions:

  • Minimal single palmar-incision carpal tunnel release without a tourniquet is an effective and reliable surgical option.
  • This technique avoids tourniquet-related pain and is particularly beneficial for patients with bleeding disorders or on hemodialysis.
  • The procedure demonstrates favorable clinical results and a good safety profile.