RESUMEN
Local anaesthesia for surgical endoscopic release of carpal ligament is obtained with a block of the median nerve associated with subcutaneous infiltration of the areas of entrance and exit of the endoscope. A palmar application of Emla cream makes the needle puncture painless. The accidental puncture of the median nerve, which occurs when the needle is inserted too rapidly, is the only potential complication. It is easily prevented by pushing the needle gently forward and orientating the bevel parallel to the axis of the nerve. The use of a neurostimulator and needle with a blunt tip can be an alternative. We used this technique in more than 1,500 patients. Only one accidental puncture of the nerve due to a technical error occurred.
Asunto(s)
Anestesia de Conducción/métodos , Síndrome del Túnel Carpiano/cirugía , Endoscopía , Procedimientos Quirúrgicos Ambulatorios , Estimulación Eléctrica , Humanos , Nervio MedianoRESUMEN
The Hand Centre of Angers in France is entirely autonomous. 2,200 patients a year undergo hand or wrist surgery under regional anaesthesia exclusively. Authors insist on the importance of pre-selection among patients. Security rules and postoperative recommendations are mandatory.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Anestesia de Conducción , Dedos/cirugía , Mano/cirugía , Francia/epidemiología , HumanosRESUMEN
From May 1983 to September 1988, we performed 41 triscaphe arthrodeses, 36 of which underwent clinical and radiologic follow-up examination. The 36 preoperative diagnoses were classified as: Kienböck's disease (16 cases), chronic rotatory subluxation of the scaphoid (static scaphoid-lunate dissociation) (13 cases), degenerative arthritis of the scapho-trapezio-trapezoid joint (4 cases), traumatic lesion of the scapho-trapezio-trapezoid joint (2 cases), 1 case of midcarpal instability with a non-dissociative VISI pattern. Average length of follow-up was 28 months. Analysis of results showed on the whole good improvement on pain and average improvement of strength; range of motion varied greatly with etiology. For example, the range of motion on the fused side in Kienböck's disease averaged 38 per cent of that of the unoperated side, whereas in other conditions it averaged 60 per cent. Radiographic analysis confirmed the efficacy of triscaphe arthrodesis in preserving normal carpal height but revealed radial styloid impingement in 34 per cent of the cases. Use of this procedure should be limited to stage 3 Kienböck's disease and to scaphoid-lunate dissociation without arthritis. Peroperative radiographic study is indispensable to verify appropriate reduction of the scaphoid and to measure the radial-scaphoid angle. Partial radial styloidectomy should be included routinely in the procedure.