Comparative Analysis of Efficacy of Endoscopic versus Open Carpal Tunnel Release

Objectives: To compare the efficacy between endoscopic and open carpal tunnel release procedures for carpal tunnel syndrome patients. Design and setting: Randomised control study in a single neurosurgery department   Participants: 30 patients aged 35-69 years with clinically diagnosed carpal tunnel syndrome   Main outcome measures: Primarily - operative duration, bleeding, pain score on day one, requirement of non-steroidal anti-inflammatory drugs (NSAIDs), time spent in hospital and days taken to return to work. Other outcomes include infection, wound status/cosmesis, injury to median nerve, chronic regional pain syndrome and patient satisfaction.   Results: 15 patients were allocated to open surgery, and the other 15 for endoscopic. The average operative duration for open surgery was 9.9 minutes compared to 52 minutes spent for the endoscopic procedure. Cauterization had to be performed 4:1 times in endoscopic compared to open. Pain scores rated 3x higher after open surgery and resulted in increased NSAIDs use. Time spent in hospital after open surgery was 0.7 hours compared to 2.2 in endoscopic, however patients were able to return to work an average of 10.6 days earlier after endoscopic surgery.   Conclusions: In carpal tunnel syndrome, endoscopic surgery allowed patients to experience less post-operative pain and return to work several days sooner than in open surgery.