Contribution of ultrasound-assisted surgery coupled with Walant anaesthesia in bilateral carpal tunnel surgery.

Introduction: The simultaneous bilateral release of carpal tunnels still remains a non-unanimous practice. We prospectively studied the contribution of ultrasound-guided surgery coupled with Walant anaesthesia in the simultaneous release of both carpal tunnels.

Materials and methods: Patients who presented bilateral clinical involvement confirmed by electromyogram were operated on in the operating room under Walant anaesthesia by minimally invasive knife section under ultrasound guidance. The follow-up focused on pain immediately after local anaesthesia, when leaving the operating room, on day 1 and then on day 7. Satisfaction on day 0, day 7 and at 3 months, complications as well as the resumption of daily activities, light manual activities then heavy manual activities were reported.

Results: 10 patients were operated on. The median average pain score was less than 1 after anaesthesia, on day 0 in the immediate postoperative period on day 1 and on day 7. Mean satisfaction was above 9 ​at day 0, day 7 and month 3. There were 2 minor postoperative complications, one spontaneously resolved after 45 days, the other requiring additional intervention on another site of compression of the median nerve upstream. Resumption of light manual activities was 3 days and heavy manual activities 31 days.

Discussion: The release of the bilateral carpal tunnel remains a rare surgical practice due to fear of pain and postoperative disability particularly during the initial postoperative period. However, the release of the carpal tunnel in ultrasound-guided surgery under Walant anaesthesia has proven painless and fast function recovery.

Conclusion: The release under Walant anaesthesia with ultrasound assistance of simultaneous bilateral carpal tunnel is safe for the patient. Patient satisfaction is high. We recommend this technique in selected patients.