Effect Of Ultrasound-guided Median Nerve Block On Carpal Tunnel Syndrome

BackgroundWith the continuous development of human society,people's work and lifestyle is changing,and population aging is growing.The incidence of carpal tunnel syndrome(CTS)is increasing year by year.Carpal tunnel syndrome(CTS)is caused by compression of the median nerve at the wrist level and the most frequent entrapment neuropathy in the upper limb.Pain,numbness,and tingling affecting first 3 to 4 fingers in the hand are the most common symptoms of CTS.Additionally,symptoms are worst at night and often wake the patient,and weakness and atrophy of the hand muscles and dysfunction of hand.The treatment options of CTS are either surgical or conservative treatments.The treatment of nerve block is one of the most common conservative option to cure the CTS.Traditional nerve block confirmed by anatomic landmark palpation includes many side effects,such as direct needle injury of the median nerve and vessels.At present,ultrasound technology has been widely used in clinical anesthesia.Therefore,it is very feasible to treat carpal tunnel syndrome by ultrasound-guided median nerve block.Objective(1)To observe the clinical effects of ultrasound-guided median nerve block on carpal tunnel syndrome.(2)Clinical comparison of ultrasound-guided using in-planar/out-planar median nerve block for carpal tunnel syndromeMethod(1)A total of 40 patients with CTS,ASA I or II,were randomly assigned into ultrasound group(group U)and control group(group C),20 cases in each.The ultrasound group underwent ultrasound-guided median nerve blocking,while the control group did through by anatomic landmark palpation.3ml of 4.5 mg bupivacaine,5mg triamcinolone acetonides and 100ug vitamin B12 was injected in a single shot in the two groups.Symptoms and functions were evaluated by Boston carpal tunnel questionnaire BCTQ)at the onset and after the treatment.Electrophysiological parameters were recorded at the time of pretreatment and post-treatment.Cases receiving treatment two or more and side effects were also recorded(2)Totally 50 patients with CTS,ASA ? or ?,were randomly divided into ultrasound-guided using in-planar group(group U-I)and out-planar group(group U-O),25 cases in each.3ml of 4.5 mg bupivacaine,5mg triamcinolone acetonides and 100ug vitamin B12 was injected in a single shot in the two groups.Using the Boston carpal tunnel questionnaire(BCTQ),the patients were evaluated for symptoms and functions before and after treatment.the secondary treatment and adverse reactions were recorded.Statistical methodsSPSS 20.0 software was used to analyze the statistical data.Measurement data of the experimental data or expressed by Mean ± standard deviation(x±s).The data of normally distributed were compared using T test?Within the group to compare using repeated measures design analysis of variance.Count data were compared using chi—square test.Compare with rank and inspection level data.Wilcoxon test level data to P<0.05 was considered statistically Significant.Result(1)There was no statistically significant difference between the two groups in gender,age and course of disease.Both the symptom severity scale(SSS)and funcational status scores(FSS)of the BCTQ showed significant decrease 1 month after treatment in the two group(P<0.05).Compared with group C,SSS of group U showed a significant decrease(P<0.05),while there was no significance difference in FSS.Compared with pretreatment,SDL3 showed a significant decrease and SNCV showed significant increase 1 month after treatment in the two group(P<0.05),while there was no significant change in the MNCV.SNCV was quicker in group U than in group C at 1 month after treatment(P<0.05),while other electrophysiological parameters were not significantly different between the two groups.Less cases with treatment times>2 and less side effects were found in group U than in group C(P<0.05).(2)There was no statistically significant difference between the two groups in gender,age and course of disease before the treatment.Compared with pre-treatment,the symptom severity score(SSS)and functional status score(FSS)of the two groups were significantly reduced(P<0.05).there was no significant difference between the two groups in the treatment times?2,but the adverse reaction of U-I group was significantly lower than that in the U-O group(P<0.05).Conclusion(1)Median nerve blocking under ultrasound guidance effectively improves the symptom in patients with carpal tunnel syndrome and reduces complications.(2)Ultrasound-guided using in-planar/out-planar median nerve block effectively improves the symptom and function in patients with carpal tunnel syndrome,and Ultrasound-guided using in-planar can educes the occurrence of adverse reactions.