Carpal Tunnel Release
Anesthesia Implications
Position: Supine, one arm extended, one arm tucked
Time: 5-30 min (very short)
Blood Loss: Zero
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
Tourniquet Use: Yes
Blocks: Bier
- MAC, Propofol Drip
- MAC, Peripheral Nerve Block, Propofol Drip
- GLMA
Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms
Tourniquet (general considerations): Antibiotics should be administered prior to tourniquet inflation. Tourniquet pain usually begins 45-60 minutes after inflation and is unresponsive to regional anesthesia and analgesics. Upper extremity pressure should be set to approximately 70-90 mmHg above systolic blood pressure (SBP). Lower extremity tourniquet pressure should be set to approximately 2 times SBP. Upon tourniquet release, there will be increases in End-tidal CO2 and metabolic acidosis, while decreases will be seen in core body temperature, blood pressure, and mixed venous oxygen saturation (SvO2)
The transverse carpal ligament is cut to relieve the pressure it is putting on the median nerve in the wrist. The incision is done on the palm of the hand roughly a centimeter distal to the wrist fold.
