内窥镜腕管松解术中的监测麻醉护理与局部麻醉：手术时间和患者报告结果分析

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2024-07-01 DOI:10.1016/j.jhsg.2024.02.014

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引用次数: 0

摘要

目的腕管综合征是临床上最常见的周围神经压迫性神经病。非手术治疗失败的患者可接受腕管松解术（CTR），该手术可通过开放或内窥镜进行。在内窥镜松解术中，人们努力使用局部麻醉来代替麻醉监护（MAC）。方法这是一项为期6年的回顾性研究，研究对象是在一家门诊手术中心接受MAC（n = 607）和局部（n = 429）麻醉的1036名孤立内窥镜CTR患者。结果局麻队列的术后出院时间（15.9 ± 9.8 vs 53.8 ± 11.0 分钟；P < .05）、在手术中心花费的总时间（83.2 ± 18.7 vs 129.3 ± 20.7 分钟；P < .05）、手术室总时间（26.7 ± 4.3 vs 29.0 ± 4.1 分钟；P < .05）和止血带时间（12.4 ± 2.5 vs 13.1 ± 2.1 分钟；P < .05）均明显缩短。两组患者的术前和术后患者报告结果测量信息系统（PROMIS）评分相似（P >.05）；但局部组患者的PROMIS疼痛干扰在术前和术后的改善程度更高（-1.5 vs -0.8；P = .02）。结论MAC组患者的术后出院时间和在手术中心的总时间更长。MAC组患者的手术室和止血带使用时间更长，但临床意义不大。两组患者的手术并发症和 PROMIS 评分相似。我们的研究结果表明，局部麻醉是内窥镜 CTR 的一种安全有效的选择，可能会为患者带来成本和便利方面的优势。研究类型/证据级别回顾性队列研究/治疗 III.

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Endoscopic Carpal Tunnel Release With Monitored Anesthesia Care Versus Local Anesthesia: Analysis of Operative Times and Patient-Reported Outcomes

Purpose

Carpal tunnel syndrome is the most common peripheral nerve compressive neuropathy in clinical practice. Patients who fail nonsurgical management are indicated for carpal tunnel release (CTR), which can be performed open or endoscopically. Efforts have been made to utilize local anesthesia instead of monitored anesthesia care (MAC) for endoscopic release. This study seeks to compare perioperative surgical times and postoperative outcomes in patients undergoing endoscopic CTR with local anesthesia versus MAC.

Methods

This is a 6-year retrospective study of 1,036 patients undergoing isolated endoscopic CTR with MAC (n = 607) versus local (n = 429) anesthesia within an outpatient surgical center. A combination of chi-square and t tests was used to compare the patient characteristics, operative details, and outcomes.

Results

The local cohort demonstrated significantly shorter postoperative time to discharge (15.9 ± 9.8 vs 53.8 ± 11.0 minutes; P < .05), total time spent in surgical center (83.2 ± 18.7 vs 129.3 ± 20.7 minutes; P < .05), shorter total operating room time (26.7 ± 4.3 vs 29.0 ± 4.1 minutes; P < .05) and tourniquet time (12.4 ± 2.5 vs 13.1 ± 2.1 minutes; P < .05). Preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores were similar between the cohorts (P > .05); however, PROMIS pain interference improved to a higher degree between pre- and post-op in the local group (−1.5 vs −0.8; P = .02). Early and late surgical complications were similar between the groups (P > .05).

Conclusions

Patients within the MAC cohort demonstrated longer postoperative time to discharge and total time in the surgical center. The MAC cohort had longer operating room and tourniquet time, albeit not clinically significant. Surgical complications and PROMIS scores were similar between the two groups. Our findings suggest that local anesthesia is a safe and effective option for endoscopic CTR and may offer advantages in cost and convenience for patients.