ulnar nerve compression

8/4/2019 ulnar nerve compression

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Somesh Beeharry Pierre Michel

Hopital Albert Schweitzer France


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Introduction

CT release

Very common procedure

High patient and surgeon satisfaction

However

Different proceduresDifferent anaesthesia


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Introduction

Highly controversial !


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Introduction

Highly controversial !


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Introduction

DefinitionCT release =

division of the TCL

Local anaesthesia =

Subcutaneous injection at the site of

the procedure


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Introduction

DefinitionObjectives

Evaluate theAdvantage andInconvenience

ofEpinephrine

in local anaesthesiafor CTS release


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Introduction


Method

Prospective study120 patientsInformed consentment obtained

Inclusive criteria :Typical CTS (+ NCS )

Exclusive criteriaThose having 2nd procedure simutaneously

Diagnosed ArteritisHigh bleeding risk (International NormalisedRatio above 2 )


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Introduction


Method

Prospective study120 patientsStandard one portal endoscopic CT release

with touniquet


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Introduction


Method


with touniquet


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Introduction


Method


with touniquet

Double blinded care giver and outcomes

accessor

Patients randomized by computer in 2 groups :

Lidocaine 1 % with epineprine 1:100000

Or without


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Introduction


Method


with touniquet

Double blinded care giver and outcomes

accessor

Patient randomized by computer in 2 groups :

Lidocaine 1 % with epinephrine 1:100000

Or without

Safe dosage form used by 75% of dentists in asurvey in Canada


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Introduction


Method

Prospective study120 patients

Injection was carried at palmar crease

5 cc25G 15 mm needle

10 minutes before procedure

Tourniquet

Average time of surgery and touniquet :5 min


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Introduction


Method

Prospective study120 patientsPrimary outcomes collectedPatient satisfaction 1-5

Pain score Visual scale 1-10

Peroperative

At injection

At surgeryAt Tourniquet


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Introduction


Method


Primary outcomes collected

Pain score Visual scale 1-10Post operative

4, 8,12 hours after surgery

Day 1, 2, 3

Medication (parcetamol ) intake


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Introduction


Method


Secondary outcomes collected

Return to daily activitiesPost operative followup

Oedema 0-3

Hematoma 0-3

Stiffness 0-3Day 1 and 15


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Introduction


Method


Secondary outcomes collected

Short DASH day 15 and 45Return to work


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Introduction


Method


2 series

39 items analysed


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Introduction


Method

ResultsSeries identicalAge

Mean age54 with55 without

0

1

2

3

4

5

6

7

2 1 2 5 2 6 2 8 3 1 3 2 3 5 3 6 3 7 3 9 4 0 4 1 4 2 4 3 4 5 4 7 4 8 4 9 5 0 5 1 5 2 5 3 5 4 5 5 5 6 5 9 6 0 6 2 6 3 6 5 6 7 7 0 7 1 7 2 7 4 7 6 7 7 7 8 7 9 8 0 8 1 8 2 8 5 8 6 8 7 8 9

avec

sans


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Introduction


Method

ResultsSeries identicalsex

0

5

10

15

20

25

30

35

women

with epinep

without


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Introduction


Method

ResultsSubjective patientsPain (score 0-10)

0

0.5

1

1.5

2

2.5

3

injection tourniquet procedure

PER OPERATIVE PAIN EVAL

with epinep

without


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Introduction


Method

ResultsPain patientsSubjective

Pain score(0-10)Post operative4 hours8 hours12 hours

0

0.5

1

1.5

2

2.5

3

4H 8H 12H

Pain eval DAY

with epinep

without


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Introduction


Method

ResultsMedication postDifference :

With epinephrineMore takingparacetamol

0

10

20

30

40

50

60

70

1 2 3

4H 8H 12paracetamol day of surg

with


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Introduction


Method

ResultsPain /MedicationMORE

In epinephrine groupAt 8 and 12 hLess at 4 h

Patients

evaluation

Medication

0

0.5

1

1.5

2

2.5

3

4H 8H 12H

Pain eval DAY

withepinep

0

10

20

30

40

50

60

70

1 2 3

4H 8H 12 Hparacetamol day of surg

w


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Introduction


Method

ResultsPain/MedicationDay 1

Without groupMore

0

0.5

1

1.5

2

2.5

Day1 8am Day1 noon Day1 8pm

Pain eval Day 1

withepinep

0

10

20

30

40

1 2 3

8am noon 8 pmday 1 paracetamol

Series1


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Introduction


Method

ResultsPainDay 2

MORE

0

0.2

0.4

0.6

0.8

11.2

1.4

1.6

1.8

1 2 3

Pain eval Day 2

With epinep

Without


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Introduction


Method

ResultsPainDay 3

MORE

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1 2 3

Pain eval Day 3

with epinep

without


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Introduction


Method

ResultsAssessor evaluationOedema (0-3)

Hematoma (0-3)Stiffness (0-3)

Mean values

DAY 1More hematomaWithout group

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1 2 3

oedema hematoma stiffnessday1

with epinep

without


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Introduction


Method

ResultsAssessor evaluationOedema (0-3)

Hematoma (0-3)Stiffness (0-3)

Mean values

DAY 15No significativedifference

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

1 2 3

oedema hematoma stiffnessday 15

with epinep

without


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Introduction


Method

Results

Short DASH

(0-100 )Day 15

0

10

20

30

40

50

with epinep without

DASH Day 15


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Introduction


Method

Results

Other criteria measured

Activities of daily life

Return to work

No difference


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Introduction


Method

Results

Conclusion

NO difference in

DASHAssesment at 15 days

Return to activities


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Introduction


Method

Results

Conclusion

difference inPatients medication intake

Patients sujective evaluation

At 4 hours post opmore in group with epinephrine

At 8 and 12 hours day 1,2 3

LESS in epinephrine group


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Introduction


Method

Results

Conclusion

NO difference inTime of procedure

Surgeons subjective point ?


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Introduction


Method

Results

Conclusion

2 questions

Should we use epinephrine inLocal AnaesthesiaFor CT release

Can we use it


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Introduction


Method

Results

Conclusion

2 questions

Should we use epinephrine inLocal AnaesthesiaFor CT release

difference in primary outcomesSurgeons point of view ?

Can we use itYes we can (at 1:100000 )


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Thank you

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ulnar nerve compression