腕管释放中浅表与深局麻浸润：一项随机临床试验

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-05-21 DOI:10.1016/j.jhsg.2025.03.002

Kristi Billard MD , Yanzhao Cheng MSTAT, PhD , Laura Sims MD , David Sauder MD

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引用次数: 0

摘要

目的：腕管松解术（CTR）通常在患者完全清醒时使用局麻（LA）进行。虽然大多数病人能忍受这种手术，但可能会有一些不适或疼痛。我们比较了两种LA浸润技术——单独皮下浸润（浅表）和皮下浸润合并腕管浸润（深部）——以确定哪种技术在CTR期间能提供更好的疼痛体验。方法招募74名参与者（80例），随机分为深浅浸润组和深浅浸润组。38人接受深度LA， 42人接受浅表LA。主要结果是在LA浸润和手术过程中疼痛和/或刺痛的存在和严重程度。我们还在手术后2、8和24小时检查了疼痛的严重程度。临床结果在基线和术后3个月用波士顿腕管问卷评分进行评估。统计学比较采用卡方检验和方差分析检验。结果参与者的平均年龄为63.04±12.92岁（女性40例，男性34例）。在深部组中，21%的人在LA浸润过程中感到疼痛，而浅表组中这一比例为9.5%，而深部组中有13.2%的人在手术过程中感到疼痛，浅表组中有11.0%的人在手术过程中感到疼痛。根据波士顿腕管调查问卷，两组患者的临床结果均有显著改善。在这项随机临床试验中，我们比较了深层和浅表LA浸润技术用于CTR，我们发现在给药期间和手术过程中经历的疼痛没有统计学上的显著差异。鉴于这些发现，我们建议采用浅表浸润进行CTR，因为它在技术上更容易，并且降低了潜在正中神经损伤的风险。研究类型/证据水平：治疗Ib。

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Superficial Versus Deep Local Anesthetic Infiltration in Carpal Tunnel Release: A Randomized Clinical Trial

Purpose

Carpal tunnel release (CTR) is commonly performed with the patient wide awake using local anesthetic (LA). Although most patients tolerate this type of procedure, there is a possibility of some discomfort or pain. We compared two LA infiltration techniques–subcutaneous infiltration alone (superficial) and subcutaneous infiltration with infiltration into the carpal tunnel (deep)–to determine which provides a better pain experience during CTR.

Methods

Seventy-four participants (n = 80 cases) were recruited and randomized to either deep or superficial LA infiltration. Thirty-eight received deep LA and 42 superficial LA. Primary outcomes were presence and severity of pain and/or tingling during the LA infiltration and during the procedure. We also examined the severity of pain at 2, 8, and 24 hours after the procedure. Clinical outcomes were assessed with the Boston Carpal Tunnel Questionnaire score at baseline and at 3 months postprocedure. Statistical comparisons were performed using chi-square and analysis of variance tests.

Results

The average age of participants was 63.04 ± 12.92 years (n = 40 females and n = 34 males). In the deep group, 21% experienced pain during LA infiltration compared to 9.5% in the superficial group, whereas 13.2% of the deep group and 11.0% of the superficial group experienced pain during the procedure. Both groups showed a significant improvement in clinical outcomes, measured by the Boston Carpal Tunnel Questionnaire.

Conclusions

In this randomized clinical trial comparing deep versus superficial LA infiltration techniques for CTR, we found that there was no statistically significant difference in the pain experienced during the administration of the LA or during the procedure. Given these findings, we recommend using superficial infiltration for CTR as it is technically easier and reduces the risk of potential median nerve injury.