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Journal of Neurosurgical Sciences 2000 June;44(2):85-8

language: English

Peri- and postoperative pain valutation in carpal tunnel release of median nerve compression

Gunetti R., Bonicalzi V., Riolo C., Pagni C. A.

Neuroscience Department, Neurosurgery Division, University of Turin, Turin, Italy


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We ana­lysed 108 ­patients, oper­at­ed on ­day sur­gery, ­for car­pal tun­nel ­release of ­median ­nerve com­pres­sion, to eval­u­ate ­peri- ­and post­op­er­a­tive ­pain. We ­made in ­all cas­es a ­short inter­ten­ar­ian inci­sion (25 mm) ­with micro­sur­gi­cal tech­nique ­and ­local anaesthe­sia ­using mepivacaine 2% with­out vas­o­con­stric­tor. We evaluatedpain ­for ­local anaesthet­ic infil­tra­tion as ­VRS (Verbal Rating Scale) 6,3 ­median-­time to ­the ­first pos­sible anal­ge­sic assump­tion (in ­all cas­es par­a­cet­a­mol 500 mg), ­total anal­ge­sic assump­tion, algom­e­try (to eval­u­ate “allo­diny”) ­after the ­first 48 ­hours ­and sub­jec­tive ­pain inten­sity by a numer­i­cal ­pain scale. Pain inten­sity on ­first ­drug assump­tion (­after a ­mean ­time of 7 ­hours ­from ­the ­end of sur­gery) ­had a ­mean ­VAS val­ue of 2,15; ­while ­after a sec­ond pressure assump­tion of anal­ge­sic (­after a ­mean ­time of 15 ­hours ­from sur­gery) ­had a ­mean ­VAS val­ue of 2. Mean ­total anal­ge­sic assump­tion ­was 1,64 tab­lets of par­a­cet­a­mol 500 mg. From ­these ­data we ­may ­deduce ­that ­peri- ­and post­op­er­a­tive ­pain fol­low­ing ­median ­nerve decom­pres­sion ­with ­this tech­nique ­and anaesthe­sia, ­has a mod­er­ate ­intense ­peak of ­brief dura­tion, ­for ­local anaesthet­ic infil­tra­tion (­that ­seems to be ­the ­most pain­ful ­event) ­and mod­est ­and ­not con­stant ­pain in ­the post­op­er­a­tive ­time (­more evi­dent 7 ­and 15 ­hours ­from ­the ­end of sur­gery). It ­may be use­ful asso­ci­a­tion ­with mepiv­a­caine bicar­bo­nate solu­tions or inject­ing ­less pain­ful ­local anaesthet­ic.

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