The majority of carpal tunnel surgeries are performed with the patient awake, using local or regional anesthesia to numb the surgical area. Carpal Tunnel Syndrome (CTS) occurs when the median nerve becomes compressed within the narrow carpal tunnel passageway in the wrist. Surgical Carpal Tunnel Release (CTR) is a common procedure to cut the transverse carpal ligament, relieving pressure on the nerve. This “awake” approach allows for a more streamlined surgical experience and faster recovery.
Types of Anesthesia Used
The most frequently employed method for carpal tunnel release is Wide Awake Local Anesthesia No Tourniquet, often referred to as WALANT. This technique involves injecting a combination of a local anesthetic, such as lidocaine, and epinephrine directly into the surgical site. The anesthetic numbs the area for the incision, while the epinephrine constricts blood vessels, minimizing bleeding. Eliminating the need for a tourniquet, which can cause discomfort, is a primary reason this method is preferred.
Another option is regional anesthesia, where an anesthetic “block” is administered, often near the shoulder or armpit, to numb the entire arm. This is a good alternative if a patient experiences significant anxiety about the procedure or if the operation is more complex. Sometimes, a patient may receive Monitored Anesthesia Care (MAC) or light intravenous sedation, commonly called “twilight sleep.”
With MAC, IV medication is given to induce a relaxed, drowsy state, but the patient is not fully unconscious. This sedation can help anxious patients, though it requires more monitoring and a longer recovery period compared to a purely local anesthetic. Full general anesthesia, where the patient is completely asleep, is rarely used for carpal tunnel release unless there are complicating medical factors.
What You Will Experience While Awake
During a procedure under local anesthesia, the patient’s hand and wrist will be completely numb, meaning there should be no sensation of pain during the nerve release. Patients often report feeling pressure, pushing, or a tugging sensation as the surgeon works. This feeling of pressure is normal because the local anesthetic only blocks pain signals, not the deep pressure receptors.
The patient remains conscious and can communicate with the surgical team throughout the procedure, a major benefit of the awake technique. They are often draped with a sterile cloth, blocking the view of the incision site. The operating room is not silent; patients will hear conversations, the sound of instruments, and sometimes music played to reduce anxiety.
This communication allows the surgeon to receive real-time feedback on any discomfort, though pain scores for the procedure are very low. In some cases, the surgeon may ask the patient to gently move their fingers to ensure the nerve is fully decompressed. The entire surgical time is brief, often lasting between 15 and 30 minutes.
Right After the Surgery Ends
Immediately after the final stitch is placed, the surgical wound is covered with a sterile dressing and a soft, bulky bandage is applied. Because the patient was not under general anesthesia or heavy sedation, the immediate recovery time is short. Patients often bypass the traditional recovery area and are ready for discharge in under an hour.
The local anesthetic injected during the surgery is long-acting and will keep the hand numb for several hours. It is important to begin taking prescribed or over-the-counter pain medication, such as acetaminophen or ibuprofen, before the numbness completely fades. Starting the medication proactively helps manage the return of sensation and prevents the pain from becoming intense.
Patients will be instructed to keep the hand elevated above the level of the heart for the first day or two to minimize swelling. Although they can move their fingers immediately, they must have a responsible adult drive them home due to the residual effects of the anesthetic and the inability to grip a steering wheel safely. The first two weeks involve keeping the dressing clean and dry and beginning gentle finger exercises to prevent stiffness.