Choice of loco-regional anesthetic technique affects operating room efficiency for carpal tunnel release
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Intravenous regional anesthesia (Bier block) is indicated for minor procedures such as carpal tunnel release but must be performed in the operating room. We hypothesize that preoperative peripheral nerve blocks decrease anesthesia-controlled time compared to Bier block for carpal tunnel release. With IRB approval, we reviewed surgical case data from a tertiary care university hospital outpatient surgery center for 1 year. Unilateral carpal tunnel release cases were grouped by anesthetic technique: (1) preoperative nerve blocks, or (2) Bier block. The primary outcome was anesthesia-controlled time (minutes). Secondary outcomes included surgical time and time for nerve block performance in minutes, when applicable. Eighty-nine cases met criteria for analysis (40 nerve block and 49 Bier block). Anesthesia-controlled time [median (10th–90th percentiles)] was shorter for the nerve block group compared to Bier block [11 (6–18) vs. 13 (9–20) min, respectively; p = 0.02). Surgical time was also shorter for the nerve block group vs. the Bier block group [13 (8–21) and 17 (10–29) min, respectively; p < 0.01), but nerve blocks took 10 (5–28) min to perform. Ultrasound-guided nerve blocks performed preoperatively reduce anesthesia-controlled time compared to Bier block and may be a useful anesthetic modality in some practice environments.
KeywordsUltrasound Anesthesia Conduction Nerve block Bier block Operating room efficiency
The authors gratefully acknowledge the editorial assistance of Dr. Steven K. Howard, Director of Clinical Research, Anesthesiology and Perioperative Care Service; VA Palo Alto Health Care System.
Conflict of interest
Dr. Mariano has received honoraria for educational programs conducted by SonoSite (Bothell, WA). This company had absolutely no input into any aspect of the present study conceptualization, design, and implementation; data collection, analysis and interpretation; or manuscript preparation. None of the other authors has any personal financial interests to disclose.
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