General anesthetic for carpal tunnel?

[Eyelashwishes]

I have had carpal tunnel syndrome ever since I was pregnant with my first child. It's gotten worse and worse and worse to the point where my middle finger on one hand is permanently numb, so I'm having to have the release surgery. I've been putting this off for a long time because I'm absolutely petrified of the idea of local anesthetic. I feel sick whenever I think about having to have this surgery whilst still awake, I am feeling so anxious about it. My surgery has been scheduled for 21st May and at this point its all I can think about. I'm just wondering if anyone has had this surgery and felt the same? Or has anyone had the same fear and managed to get them to do it under general instead? Thanks

I have had the surgery on both hands with only local anaesthetic and I was really worried about it. I’m also needle phobic. It wasn’t that bad OP. It didn’t hurt at all whilst they were doing the surgery. Best of luck for a speedy recovery

My average surgical time for these is about 8 minutes, and ive never had a patient express regret having it done under local, much faster recovery!

Some of my more curious patients have asked to see the clockwork inside the wrist, those who dont have a screen up and often dont realise the operation has even started by the time it's nearly over.

You could have the block plus sedation and you won't remember anything. I had major abdominal surgery with and epidural and sedation, can't remember a thing. My advice would be talk to the anesthetist and get them to set out all the options.

@FixTheBone how bad would it need to be before you recommend surgery, I've had this since birth of last child 13 years ago. Feel like breast feeding brought it on. Mostly just tingly at night as I avoid things that exacerbate it when awake eg arms aboth head, carrying heavy plastic bags, press ups (!) The only thing I can't avoid is typing which makes it flare up.

I did the exact opposite. I had them do it with a really localized block with a special cuff to keep the numbing medication in place and absolutely no sedation. The surgeon knew in theory what was happening, but he was still a bit surprised to find me there just alert and completely normal through the whole surgery. I walked to recovery and got to leave the hospital as quickly as they could finish my paperwork. The nurses were quite bemused by the whole thing.

it was done that way because I have a history of really bad reactions to anesthesia. So they brought in a specialist anesthesiologist who could do an unusual technique.

my suggestion is to talk to anesthesia because they do want to work with you. If they can’t do general, they may have an alternative that helps with your anxiety.

if worse comes to worse, I posted because I thought it might help knowing that it’s really not bad at all. I’ve had many surgeries and this was by far the easiest. Getting stitches is much worse. The only part that was unpleasant was that they use a plastic drape to keep the small area sterile and I got sweaty.

oh and wear a stretchy bra. You will struggle to put back on a regular one.

I had it with a local.

A nurse sat by my (other) side and talked to me all the way through. I couldn't feel anything and she kept me completely distracted.

The operation was a total success and whilst my hand was sore as the wound recovered- the relief from carpal tunnel
Was immediate.

I had both hands done at once about 7 years ago. I'm so glad I had it done as I was in a lot of pain with it. I was told that putting it off can result in nerve damage. Having it done under local was not a pleasant experience. The thing I disliked the most was the anaesthetic injections and then the torniquet they put on to stop the bleeding. However, I had a wonderful nurse who spoke to me the entire time and really looked after me. I would describe the whole thing as uncomfortable, but it was totally worth it. You're bound to feel nervous, but ultimately you'll be really pleased you went through with it. I'm just getting over a general anaesthetic which I had for a cystoscopy last Friday and the recovery has been horrible. Good luck OP x

Anaesthetist here who has had carpal tunnel decompression done under local anaesthetic. Local anaesthetic put in when I was sat up having signed the consent form -ask to lie down if you react badly to needles. Achy pressure feeling when it went in but very soon went numb. Walked around to theatre and just sat chatting to an ODP for 10 minutes or so whilst it was done. Anaesthetists are all control freaks but it was fine. Top tip though take some paracetamol (and ibuprofen if you are ok with it) before the local wears off, local had obviously soaked in to median nerve and that was very tingly as the local wore off.
General anaesthetics are very safe but not totally without risk and really not needed for this surgery. Also depending on the arrangements in your hospital it may not be possible to do one on the day. The theatre I was in doesn’t have an anaesthetic machine for example and there was not an anaesthetist assigned to the list either. Please contact them and discuss your concerns rather than take a spot and not proceed in the day as that will mean someone else cannot be called in.

I had extensive facial surgery under local anaesthetic, six procedures in all. I felt fine all the way through and after.

GA doesn't agree with me at all , feel really sick after for hours.

General anesthesia is more risky. I would recommend working with your team to get it done with a local.

I've had it under local anaesthetic and honestly you don't feel a thing. They use a Lazer light to cut the skin not a knife. The only thing I didn't like is they put the blood pressure cuff high up on your arm to restrict the blood loss. I went home about half an hour after the operation. You can't drive yourself. If you insist on a general anaesthetic there is always risk. You'll feel groggy for a couple of days and you'll be stuck in hospital all day before being allowed home.

chat to your surgeon - they are occasionally done with GA. It feels like using a sledgehammer to crack a walnut (for the reasons @FixTheBone suggests), but if that's what it takes sometimes it's the right thing. How good an idea it is for you will of course depend on your medical history etc so your own team are the only ones who can really advise you (they may also have other options you've not thought of too, eg. there are some (not many, but more than zero) anaesthetists who do hypnotherapy and are great at getting the super anxious through procedures like this)

Another anaesthetist coming to say the same thing about talking to them in advance - we regularly have carpal tunnel lists with no anaesthetist allocated, so if you did not want it done under local, you may not be able to get it done on that day. You'd have wasted your time and the theatre list would have a slot unused which could have been taken by another patient.

I don't have a huge objection to giving a GA for this if it's what the patient wants and they're otherwise well, but it does need planning in advance.

So, interpretation and application of the guidelines vary around the country.

I would say progressively worsening classical symptoms and provocation signs and trying non ooperative meaaures (splints, change in activity etc) and possibly a steroid injection, then its probably worth talking to a surgeon who does a lot of these to consider it, if you have muscle loss or unremitting loss of feeling I would ask to be referred urgently as these things may nkt improve, but you can stop them getting worse.

Thank you all so much for your replies. Might sound silly but the thing that I'm actually scared of isn't even the pain, it's being able to feel what's going on or my hand being pulled about. I'm not sure if that makes sense! I've never had any sort of surgery whatsoever, so I think that adds to the anxiety as I really do not know what to expect. I'm going to call tomorrow and see if I can speak to someone about what my options could be. All of you saying you couldn't feel anything and that it was worth it have helped calm my nerves a little, maybe I'll come back and read all your replies right before I go in!

How did you get on @Eyelashwishes ? Hope you’ve been able to sort something out

I promise you can't feel anything, no prodding or poking or any tugging. I've had both done under local. I did have a sedative the first time though but braved it without second time and it was fine.

I'm like you when it comes to these things, so if I can do it (twice!) you can I'm quite sure. It was such a relief to get my fingers back to normal, so keep that in mind.

Good luck OP!

@gassylady well they've said the hospital om having the surgery at don't do general, only local. So it will be that only and they won't do any sedation or anything. So I've got to decide whether I move it to another hospital and have it under general or I just brave it and hope that I can cope with just the local without passing out!

I had a knee replacement with a spinal block and no general anaesthetic last May and also had bi-lateral CTR surgery a few years ago with local and tourniquets and neither was anywhere near as traumatic as I had feared it would be. The feeling I had after a general when I had shoulder surgery? That lasted days and was just awful. Go with local but do express your fears to the team looking after you.

@Eyelashwishes i really think it will be fine. It’s likely to last 10 minutes or so. What would work best to distract you - a film to watch on iPad, music to listen to, someone to chat with? All of these can be great to take your mind off what’s going on. Almost everyone who works in theatres is skilled in inane distracting chatter 😁 I’ve used all of these with people having various ops in the last month or so all went well.

Thanks everyone one. I'm going to go with the local and just hope I can cope ok 🤞🏻 going to take my headphones and put on a podcast I think!

Did you have your surgery yet?

Yes I had it Tuesday with only local. I managed but I did find it very hard! I thought the local gong in was a but painful and then I could still feel pain as they made the initial incision and the stitches. Recovering well though and already getting the feeling back in my fingers so I'm very glad I had it done.

Well done! Brilliant that the feeling is already returning and that you were glad for going through with it.