Somesh Beeharry Pierre Michel Hopital Albert Schweitzer France

Somesh Beeharry Pierre Michel Hopital Albert Schweitzer France
Introduction
CT release Very common procedure High patient and surgeon satisfaction However
Different procedures Different anaesthesia
Introduction Highly controversial !
Introduction Highly controversial !
Introduction Definition
CT release = division of the TCL Local anaesthesia = Subcutaneous injection at the site of the procedure
Introduction Definition Objectives
Evaluate the Advantage and Inconvenience of Epinephrine in local anaesthesia for CTS release
Introduction Definition Objectives Method
Prospective study 120 patients Informed consentment obtained Inclusive criteria :

Typical CTS (+ NCS )
Exclusive criteria
Those having 2nd procedure simutaneously Diagnosed Arteritis High bleeding risk (International Normalised Ratio above 2 )
Prospective study 120 patients

Standard one portal endoscopic CT release with touniquet

Standard one portal endoscopic CT release with touniquet

Standard 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

Standard 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 a survey in Canada

Injection was carried at palmar crease 5 cc 25G 15 mm needle 10 minutes before procedure Tourniquet Average time of surgery and touniquet :5 min
Prospective study 120 patients Primary outcomes collected Patient satisfaction 1-5 Pain score Visual scale 1-10 Peroperative At injection At surgery At Tourniquet
Prospective study 120 patients Primary outcomes collected Pain score Visual scale 1-10 Post operative 4, 8,12 hours after surgery Day 1, 2, 3 Medication (parcetamol ) intake
Prospective study 120 patients Secondary outcomes collected Return to daily activities Post operative followup Oedema 0-3 Hematoma 0-3 Stiffness 0-3 Day 1 and 15
Prospective study 120 patients Secondary outcomes collected Short DASH day 15 and 45 Return to work
Prospective study 120 patients 2 series 39 items analysed
Introduction Definition Objectives Method Results Series identical Age Mean age 54 with 55 without
4
avec sans
0
21 25 26 28 31 32 35 36 37 39 40 41 42 43 45 47 48 49 50 51 52 53 54 55 56 59 60 62 63 65 67 70 71 72 74 76 77 78 79 80 81 82 85 86 87 89
Introduction Definition Objectives Method Results Series identical sex
35 30 25 20 15 10
with epinep without
5
0 women
Introduction Definition Objectives Method Results Subjective patients Pain (score 0-10)
PER OPERATIVE PAIN EVAL

3
2.5 2 1.5 1
with epinep without
0.5
0 injection tourniquet procedure
Introduction Definition Objectives Method Results Pain patients Subjective Pain score (0-10) Post operative 4 hours 8 hours 12 hours
Pain eval DAY
3 2.5 2 1.5 1 0.5 0 4H 8H 12H

with epinep
without
Introduction Definition Objectives Method Results Medication post Difference : With epinephrine More taking paracetamol
4H
8H paracetamol day of surg
12
70 60 50 40 30 20 10 0 1 2 3
with
Introduction Definition Objectives Method Results Pain /Medication MORE In epinephrine group At 8 and 12 h Less at 4 h
Pain eval DAY

3 2.5 2 1.5 1 0.5 0 4H 8H 12H
with epinep
Patients evaluation
70 60
4H 8H 12 H paracetamol day of surg
Medication
50 40 30 20 10 0 1 2 3
w
Introduction Definition Objectives Method Results Pain/Medication Day 1 Without group More
Pain eval Day 1

2.5 2 1.5
with epinep
1 0.5
0 Day1 8am Day1 noon Day1 8pm
8am
noon day 1 paracetamol
8 pm
40 30 20 10 0 1 2 3
Serie s1
Introduction Definition Objectives Method Results Pain Day 2 MORE
Pain eval Day 2
1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1 2 3
With epinep Without
Introduction Definition Objectives Method Results Pain Day 3 MORE
Pain eval Day 3
1.6 1.4 1.2
1
0.8 0.6 0.4 0.2 0 1 2 3
with epinep without
Introduction Definition Objectives Method Results Assessor evaluation Oedema (0-3) Hematoma (0-3) Stiffness (0-3) Mean values
oedema
hematoma day1
stiffness
DAY 1 More hematoma Without group
1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1 2 3
with epinep without
Introduction Definition Objectives Method Results Assessor evaluation Oedema (0-3) Hematoma (0-3) Stiffness (0-3) Mean values
oedema
hematoma day 15
stiffness
0.14 0.12 0.1 0.08 0.06 0.04 0.02

with epinep without
DAY 15 No significative difference
0
1 2 3
Introduction Definition Objectives Method Results Short DASH (0-100 ) Day 15

50 40 30 20 10 0 with epinep
DASH Day 15
without
Introduction Definition Objectives Method Results
Other criteria measured Activities of daily life Return to work No difference
Introduction Definition Objectives Method Results
NO difference in DASH Assesment at 15 days Return to activities
Conclusion
Introduction Definition Objectives Method Results Conclusion
difference in Patients medication intake Patients sujective evaluation At 4 hours post op more in group with epinephrine
At 8 and 12 hours day 1,2 3 LESS in epinephrine group

Introduction Definition Objectives Method Results Conclusion
NO difference in Time of procedure Surgeons subjective point ?
Introduction Definition Objectives Method Results Conclusion 2 questions
Should we use epinephrine in Local Anaesthesia For CT release
Can we use it
Introduction Definition Objectives Method Results Conclusion 2 questions
Should we use epinephrine in Local Anaesthesia For CT release difference in primary outcomes Surgeons point of view ? Can we use it Yes we can (at 1:100000 )
Thank you

Somesh Beeharry Pierre Michel Hopital Albert Schweitzer France

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Somesh Beeharry Pierre Michel Hopital Albert Schweitzer France

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Somesh Beeharry Pierre Michel Hopital Albert Schweitzer France

Different procedures Different anaesthesia