Endoscopic Carpal Tunnel Release With Monitored Anesthesia Care Versus Local Anesthesia: Analysis of Operative Times and Patient-Reported Outcomes

Purpose Carpal tunnel syndrome is the most common peripheral nerve compressive neuropathy in clinical practice. Patients who fail nonsurgical management are indicated for carpal tunnel release (CTR), which can be performed open or endoscopically. Efforts have been made to utilize local anesthesia instead of monitored anesthesia care (MAC) for endoscopic release. This study seeks to compare perioperative surgical times and postoperative outcomes in patients undergoing endoscopic CTR with local anesthesia versus MAC. Methods This is a 6-year retrospective study of 1,036 patients undergoing isolated endoscopic CTR with MAC (n = 607) versus local (n = 429) anesthesia within an outpatient surgical center. A combination of chi-square and t tests was used to compare the patient characteristics, operative details, and outcomes. Results The local cohort demonstrated significantly shorter postoperative time to discharge (15.9 ± 9.8 vs 53.8 ± 11.0 minutes; P < .05) and total time spent in surgical center (83.2 ± 18.7 vs 129.3 ± 20.7 minutes; P < .05) and shorter total operating room time (26.7 ± 4.3 vs 29.0 ± 4.1 minutes; P < .05) and tourniquet time (12.4 ± 2.5 vs 13.1 ± 2.1 minutes; P < .05). Preoperative and postoperative Patient-Reported Outcomes Measurement Information System scores were similar between the cohorts (P > .05); however, Patient-Reported Outcomes Measurement Information System pain interference improved to a higher degree between pre- and post-op in the local group (−1.5 vs −0.8; P = .02). Early and late surgical complications were similar between the groups (P > .05). Conclusions Patients within the MAC cohort demonstrated longer postoperative time to discharge and time in the surgical center. The MAC cohort had longer operating room and tourniquet time, albeit not clinically significant. Surgical complications and Patient-Reported Outcomes Measurement Information System scores were similar between the two groups. Our findings suggest that local anesthesia is a safe and effective option for endoscopic CTR and may offer advantages in cost and convenience for patients. Type of study/level of evidence Retrospective cohort study/therapeutic III.