Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand
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Randomized Controlled Trial Comparative Study
Short versus long-acting local anaesthetic in open carpal tunnel release: which provides better preemptive analgesia in the first 24 hours?
Open carpal tunnel release is commonly performed under local anaesthesia. No study has compared intra-operative short- versus long-acting local anaesthetics as preemptive analgesics in carpal tunnel surgery. In this single-blinded prospective study, 100 consecutive carpal tunnel releases were performed by a single surgeon at one institution with either lignocaine (n = 50) or ropivacaine (n = 50). ⋯ The time to the first postoperative pain was significantly shorter in the lignocaine group (5.58 vs. 9.17 hours, p < 0.035). There were no significant difference in the incidence of poor first night's sleep (16% vs. 26%, p = 0.28) or mean pain scores in the first day (3.6 vs. 2.9, p = 0.16). Existing evidence advocates for long-acting intraoperative local anaesthetic because it results in a longer duration of postoperative analgesia, however, our study suggests that it may also result in a poorer first night's sleep.
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Randomized Controlled Trial Comparative Study
Proximal phalanx injection for trigger finger: randomized controlled trial.
Trigger finger is one of the most common upper extremity problems in the outpatient department. Conservative treatment is the mainstay for management of trigger digits especially steroid injection with highly satisfactory outcome and minimal complication. Conventional injection technique (CI) that approaches flexor tendon sheath over metacarpal head directly causes pain for most patients. ⋯ The P1I technique group had a significantly lower pain score than CI technique group (p < 0.001). The recurrence rate was 15% in the CI technique when compared to 25% in the P1I technique which was not significant (p = 0.685). We concluded that the P1I technique is less painful than the CI technique without any significant difference in recurrence rate between the two groups at three months follow-up.
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Randomized Controlled Trial Comparative Study
Intra-tendon sheath injection for trigger finger: the randomized controlled trial.
The most common technique used for non-surgical treatment of trigger fingers is the direct injection of steroids into the flexor tendon sheath over the metacarpal head. However, this method causes more pian to the patient and can result in tendon rupture due to insertion of needle into the tendon. Carlson and Curtis described the mid-axial injection technique which is simple and relatively painless. ⋯ There were no complications from the injections in both methods. However, the recurrent rate seems to be higher in the conventional technique (p = 0.23). We concluded that the MAI injection technique provided less pain result than the CI technique and there were no complications from this injection technique.
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Randomized Controlled Trial Comparative Study Clinical Trial
Skin closure in carpal tunnel surgery: a prospective comparative study between nylon, polyglactin 910 and stainless steel sutures.
To compare the cosmetic outcome, pain and tenderness around the operation scar of carpal tunnel syndrome surgery using either nylon, polyglactin 910 or stainless steel sutures for skin closure. ⋯ Nylon and stainless steel sutures are both suitable for skin closure after carpal tunnel surgery. Based on this study, absorbable vicryl sutures should not be used, since the incidence of infections and the presence of suture granulomas was much higher than in the nylon and steel suture groups.
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Randomized Controlled Trial Clinical Trial
Retrograde tracing and electrophysiological findings of collateral sprouting after end-to-side neurorrhaphy.
The aim of this study was to seek more potent evidences of collateral sprouting for both motor and sensory nerve fibres after end-to-side neurorrhaphy using a modified double-labelling retrograde tracing method and to investigate the function of regenerated motor axons with electrophysiological evaluation. Four groups (n=4 for each group) were used: end-to-end coaptation (six months postoperatively), end-to-side coaptation (four months and six months postoperatively) and normal control. Two fluorescent tracers (true blue and diamidino yellow) were applied to the proximal ends of tibial and common peroneal nerves, respectively after four or six months of nerve coaptation. ⋯ Four months after surgery, the motor nerve conduction velocity in end-to-side coaptation was significantly slower than in the normal control. But no difference was found in the sixth month. These results suggest that end-to-side neurorrhaphy can induce the functional collateral sprouting of both motor and sensory axons in the peripheral nerve.