Hole-In-One Local Anesthesia For Wide-Awake Carpal Tunnel Surgery

Author(s): Lalonde DH

Source: Plast Reconstr Surg. 126(5):1642-1644, November 2010.


​This study is accompanied by online video demonstrating the author’s technique of infiltration of local anesthesia for carpal tunnel release which does not require sedation, a separate anesthesia provider, or tourniquet.  The author points out that differences between the commonly performed carpal tunnel release in the U.S. and Canada are significant.  In the U.S., these operations are most frequently performed in an operating room with an anesthesia provider supplying sedation or regional block or both.  In Canada, the author reports that most such surgeries (90%) are performed with local anesthesia only.  A total of 20 mL of 1% Lidocaine with epinephrine (1:100,000) is used and can be further diluted by 75% to 0.25% lidocaine with epinephrine (1:400,000) with the same results if lidocaine or epinephrine total dose is a concern in individual patients.  The injection is performed first in the wrist under the antebrachial fascia with 10cc which is the only injection the patient feels.  The injections then proceeds from points of anesthetized injection sites.  No tourniquet is necessary due to the vasoconstrictive effects of the epinephrine. 

The author reports that the patients can be pre-injected in the pre-operative holding area well before their time to be taken to the procedure room and the patients are fully awake at the procedural conclusion to receive post-operative instructions from the surgeon.  The author has found a substantial increase in efficiency using this method and eliminating an additional anesthesia provider from the procedure.  Video for this procedure may be found at www.PRSjournal.com.