psd-502 and Carpal-Tunnel-Syndrome

Guided plasticity, induced by cutaneous forearm anaesthesia, improves hand sensibility in patients with nerve injury and vibration-induced neuropathy. This study investigated whether patients with carpal tunnel syndrome (CTS) would benefit from cutaneous forearm anaesthesia.. Seventy patients with clinical and electroneurography-verified CTS were randomised to sensory training combined with either an anaesthetic cream (EMLA. There were no significant differences in primary or secondary outcomes between the groups. However, the BCTQ symptom severity scale improved significantly within the EMLA. An 8-week treatment protocol with cutaneous forearm anaesthesia to guide brain plasticity gave no significant subjective or objective improvements in hand function compared to placebo.

Topics: Anesthetics, Local; Carpal Tunnel Syndrome; Female; Forearm; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Neural Conduction; Neurologic Examination; Neuronal Plasticity; Prilocaine; Prospective Studies; Sensory Thresholds

This randomized, double-blinded study assessed the effectiveness of a topical anaesthetic, eutectic mixture of local anaesthetics (EMLA), in reducing pain associated with carpal tunnel release performed under local anaesthetic. Fifty-six patients undergoing carpal tunnel release under local anaesthetic were randomized into either EMLA (n = 29) or placebo (n = 27) groups. Visual analogue pain scores were obtained for needle insertion, injection of anaesthetic and surgery itself. Pain scores were significantly less for needle insertion (P = 0.001) and injection of anaesthetic (P = 0.0005). Scores related to surgery were also lower in the EMLA group, but this did not reach statistical significance.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Carpal Tunnel Syndrome; Double-Blind Method; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Needles; Ointments; Pain Measurement; Pain, Postoperative; Preoperative Care; Prilocaine; Time Factors

Patients treated by open carpal tunnel decompression under local anaesthetic experience significant pain with the introduction of local anaesthetic before operation. A prospective double-blind randomized placebo controlled trial was carried out to assess whether this pain could be reduced with the pre-application of a topical lignocaine-prilocaine anaesthetic cream. Nineteen patients undergoing simultaneous bilateral operations were studied. Pain, measured with a visual analogue scale, was significantly reduced on the sides treated with anaesthetic cream. On a four point verbal scale the rating on the placebo side was "moderate" or "severe", compared to "mild" on the anaesthetic cream side. The reduction in pain was greater in women, possibly due to a relatively thinner dermis. There were no adverse effects.

Topics: Anesthetics, Local; Carpal Tunnel Syndrome; Decompression, Surgical; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies

Several peripheral nerve block techniques (PNB) are performed for hand surgery. Their tolerance by patients or their efficacy are poorly described. We evaluated them for blocks at the wrist and at the brachial canal.. Cohort of outpatients undergoing open carpal tunnel release under PNB with arm tourniquet. Various anaesthetic protocols existed in our staff. The primary end points were a moderate to severe pain (greater than 3/10 on a numerical rating scale) felt during needle puncture, nerve stimulation, mepivacaine injection, at the surgical site (intraoperatively) or at the arm tourniquet, an intraoperative lidocaine supplementation, the occurrence of vasovagal events. For each primary end point, a logistic regression analyzed: the effects of gender, age, operated side, Emla(®)application, sedation before PNB (midazolam-sufentanil), wrist or brachial canal approach, musculocutaneous or radial block were using.. Between January 2007 and June 2010, 551 consecutive patients were analyzed. Puncture pain, mepivacaine injection pain, pain tourniquet and vasovagal events were associated with wrist block (P=0.003, relative risk=1.86; P<0.001, RR=4.22; P<0.001, RR=4.52; P=0.035, RR=6.40). An intraoperative pain greater than 3/10 at the surgical site, or a supplementation by the surgeon were associated with the absence of musculocutaneous block (P=0.013, RR=2.44; P=0.013, RR=2.51).. Wrist blocks are less tolerated than brachial canal blocks. The musculocutaneous nerve might often participate in the palm sensitive innervation. For open carpal tunnel release, median, ulnar and musculocutaneous nerves blocks at the brachial canal should be preferred.

Topics: Adult; Aged; Ambulatory Surgical Procedures; Analgesics, Opioid; Anesthetics, Local; Brachial Plexus; Carpal Tunnel Syndrome; Cohort Studies; Electric Stimulation; Endpoint Determination; Female; Hand; Humans; Hypnotics and Sedatives; Lidocaine; Lidocaine, Prilocaine Drug Combination; Logistic Models; Male; Mepivacaine; Midazolam; Middle Aged; Needles; Nerve Block; Orthopedic Procedures; Pain Measurement; Prilocaine; Sufentanil; Tourniquets; Wrist

Topics: Anesthetics, Local; Carpal Tunnel Syndrome; Decompression, Surgical; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain Measurement; Prilocaine