Carpal Tunnel Surgery Can Be Done Safely In An Office-Based Setting Interview with:
Dr. Stephen Duquette MD
Indiana University Department of Surgery, Division of Plastic Surgery
R.L Roudebush VA  Indianapolis, IN

Medical Research: What is the background for this study? What are the main findings?

Dr. Duquette: Carpal tunnel syndrome is the most common compressive peripheral neuropathy, causing pain, numbness and weakness.  Conservative treatment options include splinting, NSAID pain medications, and steroid injections.  Most often the definitive therapy is carpal tunnel release (CTR).  Over 500,000 procedures are performed in the US yearly, making it one of the most commonly performed hand surgery procedures.  In the United States it is most common to perform this operation in the operating room, under sedation and locoregional anesthesia.  Because it is a very common disease that is treated surgically, process improvement can have a major impact in time to OR, patient recovery, patient satisfaction, and overall throughput.  This is especially valuable in the Veterans Administration (VA) system, where recent problems have arisen due to lack of adequate resources to care for all veterans.

This study examined the impact of opening an office-based procedure room in a VA to perform awake hand surgery under local anesthesia only.   This was compared to the prior practice of operating room carpal tunnel release though a number of performance metrics, including time to OR and complications.  Although office carpal tunnel releases are performed routinely in Canada, some surgeons still believe that the complications would increase outside the very sterile environment of the operating room.

The current study showed that wait times from initial consultation and initial visit to surgical intervention were significantly decreased in the procedure room group compared to the operating room.  The complication rate was the same for both groups, showing that the procedure room and the operating room were both equally safe and efficacious in providing an environment that was ideal for the performance of carpal tunnel releases.

Medical Research: What should clinicians and patients take away from your report?

Dr. Duquette: This study suggests that open carpal tunnel release in an office-based setting is an equally safe and effective surgical option for people suffering from carpal tunnel syndrome.   The office-based environment also decreases wait time from initial consultation to surgical intervention, which both referring clinicians and patients will appreciate

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Duquette: Now that office-based open carpal tunnel release has been shown to decrease wait times and have similar complication rates compared to the procedure in the OR, future studies may focus on a cost comparison analysis between the OR and an office-based procedure room.  The OR is usually one of the largest costs to any hospital, and removing cases from it would likely significantly reduce costs.  Additionally, patient satisfaction should be a target of future studies.  The benefits of reduced waiting times, no systemic anesthesia, improved recovery, and quicker recovery should be weighed against the downside of having surgery performed on an awake (but completely insensate) patient.


Duquette S, Nosrati N, Cohen A, Munshi I, Tholpady S. Decreased Wait Times After Institution of Office-Based Hand Surgery in a Veterans Administration Setting. JAMA Surg. 2015;150(2):182-183. doi:10.1001/jamasurg.2014.1239. Interview with:Dr. Stephen Duquette MD (2015). Carpal Tunnel Syndrome Surgery Can Be Done Safely In An Office-Based Setting
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Last Updated on March 3, 2015 by Marie Benz MD FAAD