Carpal Tunnel Syndrome (CTS) causes numbness, tingling, and weakness in the hand due to pressure on the median nerve in the wrist. Carpal Tunnel Release (CTR) surgery is a common and highly effective outpatient procedure performed to alleviate this pressure. Since the surgery is generally brief and does not require deep intervention, patients have multiple options for remaining conscious or being fully anesthetized. The choice of anesthetic approach depends on the patient’s anxiety level, overall health, and the surgeon’s preference.
The Primary Anesthesia Choices
Three main anesthetic methods are widely used for carpal tunnel release, two of which allow the patient to remain awake. The most common approach is local anesthesia, often referred to as “wide awake surgery,” where only the surgical site on the hand and wrist is numbed with an injection. Medications like lidocaine, sometimes combined with epinephrine to minimize bleeding, are injected directly around the carpal tunnel area. This method prevents pain signals from reaching the brain, allowing the patient to be alert and comfortable throughout the procedure.
Another option that keeps the patient conscious is regional anesthesia, typically involving an arm block. This technique involves injecting an anesthetic agent near the nerves higher up in the arm, such as in the armpit (axillary block), to numb the entire limb.
General anesthesia, which puts the patient fully unconscious, is the least common choice for this routine outpatient surgery. This method is reserved for patients who experience high anxiety or those with specific underlying health conditions. Patients must recover from the systemic effects of the medication, which can include temporary grogginess or nausea.
Preparing for Anesthesia and Surgery
Preparation for CTR surgery begins well before the procedure, with requirements varying based on the anticipated anesthetic choice. If general anesthesia or deep sedation is a possibility, patients are typically instructed to fast, meaning they cannot eat or drink anything after midnight the night before. This fasting is a safety measure to prevent the risk of pulmonary aspiration—inhaling stomach contents—while under deep sedation or general anesthesia. Patients receiving local anesthesia alone may be able to eat and drink normally, bypassing the need for fasting.
Regardless of the anesthetic choice, pre-operative paperwork is required, including signing an informed consent form. This document confirms the patient understands the surgical procedure, its risks, and the chosen anesthetic plan.
An intravenous (IV) line is often placed in the non-operative arm, even for local or regional procedures. This is primarily to administer light sedation for relaxation or to be ready for emergency medication administration if needed.
Some patients may require pre-operative testing, such as blood work or an electrocardiogram (ECG), depending on their age and existing medical conditions. Patients are advised to stop taking blood-thinning medications, such as NSAIDs or aspirin, for a specified period before the surgery to reduce the risk of excessive bleeding.
Immediate Post-Operative Monitoring and Discharge
Immediately following the carpal tunnel release, the patient is moved to a Post-Anesthesia Care Unit (PACU) for monitoring. The nursing staff closely observes vital signs, including heart rate, blood pressure, and oxygen saturation, to ensure stability after the anesthetic. Patients who received general anesthesia are monitored as they wake up and become fully alert, while those who had a regional block are monitored for the gradual return of sensation to the arm.
Pain management begins in the recovery area, with most patients needing only simple, over-the-counter pain relievers, as severe pain is uncommon. The surgical hand is dressed and often elevated to minimize swelling, which is an important step in the initial healing process. The goal is to keep the hand elevated above heart level for the first couple of days.
Discharge from the facility is permitted once the patient meets specific criteria, which include stable vital signs, adequate pain control, and the ability to tolerate clear liquids, if fasting was required. All patients must arrange for a responsible adult to drive them home, as driving is prohibited for at least 24 hours after any anesthetic or sedation. The entire process, from arrival to discharge, is typically completed within a few hours.