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8/4/2019 ulnar nerve compression
1/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
8/4/2019 ulnar nerve compression
2/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
CT release
Very common procedure
High patient and surgeon satisfaction
However
Different proceduresDifferent anaesthesia
8/4/2019 ulnar nerve compression
3/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
Highly controversial !
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
Highly controversial !
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionCT release =
division of the TCL
Local anaesthesia =
Subcutaneous injection at the site of
the procedure
8/4/2019 ulnar nerve compression
6/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Evaluate theAdvantage andInconvenience
ofEpinephrine
in local anaesthesiafor CTS release
8/4/2019 ulnar nerve compression
7/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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 )
8/4/2019 ulnar nerve compression
8/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patientsStandard one portal endoscopic CT release
with touniquet
8/4/2019 ulnar nerve compression
9/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patientsStandard one portal endoscopic CT release
with touniquet
8/4/2019 ulnar nerve compression
10/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patientsStandard one portal endoscopic CT release
with touniquet
Double blinded care giver and outcomes
accessor
Patients randomized by computer in 2 groups :
Lidocaine 1 % with epineprine 1:100000
Or without
8/4/2019 ulnar nerve compression
11/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patientsStandard one portal endoscopic CT release
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
8/4/2019 ulnar nerve compression
12/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patientsPrimary outcomes collectedPatient satisfaction 1-5
Pain score Visual scale 1-10
Peroperative
At injection
At surgeryAt Tourniquet
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patients
Primary outcomes collected
Pain score Visual scale 1-10Post operative
4, 8,12 hours after surgery
Day 1, 2, 3
Medication (parcetamol ) intake
8/4/2019 ulnar nerve compression
15/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patients
Secondary outcomes collected
Return to daily activitiesPost operative followup
Oedema 0-3
Hematoma 0-3
Stiffness 0-3Day 1 and 15
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patients
Secondary outcomes collected
Short DASH day 15 and 45Return to work
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Prospective study120 patients
2 series
39 items analysed
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
ResultsSeries identicalsex
0
5
10
15
20
25
30
35
women
with epinep
without
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
21/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
22/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
ResultsMedication postDifference :
With epinephrineMore takingparacetamol
0
10
20
30
40
50
60
70
1 2 3
4H 8H 12paracetamol day of surg
with
8/4/2019 ulnar nerve compression
23/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
27/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
28/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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
8/4/2019 ulnar nerve compression
29/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Results
Short DASH
(0-100 )Day 15
0
10
20
30
40
50
with epinep without
DASH Day 15
8/4/2019 ulnar nerve compression
30/36
Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Results
Other criteria measured
Activities of daily life
Return to work
No difference
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Results
Conclusion
NO difference in
DASHAssesment at 15 days
Return to activities
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Results
Conclusion
NO difference inTime of procedure
Surgeons subjective point ?
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
Method
Results
Conclusion
2 questions
Should we use epinephrine inLocal AnaesthesiaFor CT release
Can we use it
8/4/2019 ulnar nerve compression
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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Introduction
DefinitionObjectives
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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Somesh Beeharry Pierre Michel
Hopital Albert Schweitzer France
Thank you
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