A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation.

BACKGROUND: Hand surgery under local anesthesia only has been used more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release performed under local anesthesia ( wide-awake local anesthesia no tourniquet, or WALANT) only to carpal tunnel release performed under intravenous sedation. METHODS: A retrospective comparison of intraoperative (operating room) surgical time and postoperative (postanesthesia care unit) time for consecutive carpal tunnel release procedures performed under both intravenous sedation and wide-awake local anesthesia was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost analysis was performed by means of standardized anesthesia billing based on base units, time, and conversion rates. RESULTS: There were no significant differences between the two groups in terms of total operative time, 28 minutes in the intravenous sedation group versus 26 minutes in the wide-awake local anesthesia group. Postanesthesia care unit times were significantly longer in the intravenous sedation group (84 minutes) compared to the wide-awake local anesthesia group (7 minutes). Depending on conversion rates used, a total of $139 to$432 was saved in each case performed with wide-awake local anesthesia by not using anesthesia services. In addition, a range of $1320 to$1613 was saved for the full episode of care, including anesthesia costs, operating room time, and postanesthesia care unit time for each patient undergoing wide-awake local anesthesia carpal tunnel release. CONCLUSION: Carpal tunnel release surgery performed with the wide-awake local anesthesia technique offers significant reduction in cost for use of anesthesia and postanesthesia care unit resources

Monroe, County of and Monroe County Part-Time Employees, CSEA, Local 1000 AFSCME, AFL-CIO

In the matter of the fact-finding between the County of Monroe, employer, and the CSEA (Monroe County Part-time Employees), union. PERB case no. M2009-239. Before: Stephen P. LaLonde, fact finder

Lyons Central School District and Lyons Teachers Association

In the matter of the fact-finding between the Lyons Central School District, employer, and the Lyons Teachers Association, union. PERB case no. M2013-086. Before: Stephen P. LaLonde, fact finder

West Irondequoit Central School District and West Irondequoit Teachers Association

In the matter of the fact-finding between the West Irondequoit Central School District, employer, and the West Irondequoit Teachers Association, union. PERB case no. M2013-095. Before: Stephen P. LaLonde, fact finder

Wayne, County of & Sheriff of Wayne County and Wayne County Sheriffs Court Officers Association

In the matter of the fact-finding between the County of Wayne & Sheriff of Wayne County, employer, and the Wayne County Sheriff\u27s Court Officers Association, union. PERB case no. M2010-008

Wheatland-Chili Central School District and Wheatland-Chili Federation of Teachers (Bus Drivers, Custodians & Cafeteria Workers Unit)

In the Matter of Fact-Finding Between Wheatland-Chili Central School District and Wheatland-Chili Federation of Teachers (Bus Drivers, Custodians & Cafeteria Workers Unit). PERB Case No. M2007-142. Before: Stephen P. LaLonde, Impartial Fact Finder