Wide Awake Carpal Tunnel Release in Patients with Psychiatric Diagnoses at a Military Medical Center
Haripriya Ayyala, MD, Nikki Castel, MD, Omar Mohamed, MD, Erica Xue, MD, Edward Lee, MD.
Rutgers-NJMS, Newark, NJ, USA.
BACKGROUND: Wide awake hand surgery is widely used for carpal tunnel release, one of the most common hand procedures performed in military medical centers. In this patient population, there is an increased prevalence of psychiatric disorders. We propose that there is no difference in operating time, need for sedation, or complications in the general military patient population versus those with a psychiatric history. METHODS: An institutional review board approved, retrospective cohort study was performed on 58 open carpal tunnel releases at a military medical center from January 2013 to January 2017 by a single surgeon. Patients were divided into two groups: patients with no psychiatric history (n=33) and patients with psychiatric history (n=25), including post-traumatic stress disorder, anxiety disorder, bipolar disorder, depression, substance abuse, or panic disorder. Primary endpoints included operation time, need for sedation, and complication rate. The data was analyzed utilizing Pearson’s chi-squared for nominal variables, and independent two tailed t-test and analysis of variance for quantitative variables.
RESULTS: Fifty-nine percent of patients successfully underwent wide awake hand surgery while 41% required sedation. Patients with no psychiatric history had a 45.5% rate of requesting sedation compared to 36% in those with a psychiatric diagnosis. No patients converted from wide awake surgery to sedation. There was no statistically significant difference in operation time, time in the operating room, need for sedation, or complication rate between all groups.
CONCLUSIONS: Wide awake hand surgery is an excellent technique that can be safely used in patients with a history of psychiatric illness. Without the need for monitored anesthesia care, the cost for carpal tunnel releases done in military medical centers could decrease dramatically.
Back to 2018 Posters
