Open Carpal Tunnel Decompression by Specialist versus Nurse Practitioner

Abstract

Purpose. To compare the outcome after open carpal tunnel decompression by specialists versus a nurse practitioner. Methods. Of 1361 cases of open carpel tunnel decompression under local anaesthesia from 1996 to 2008, 807 were performed by specialists (consultant, specialist registrar, or specialty and associate specialist) and 554 by a nurse practitioner (since May 2006). The 2 groups were compared in terms of surgical time, total theatre time, postoperative pain, and patient satisfaction with the service. Results. The mean surgical time was shorter in cases performed by specialists (13 vs. 18 minutes, p<0.0001), as was the mean total theatre time (26 vs. 29 minutes, p=0.0154). The rate of postoperative pain was higher in cases performed by specialists (31.5% vs. 24.5%, p=0.0125), as was the rate of patient dissatisfaction (1.6% vs. 0.18%, 0.0113). Nonetheless, since May 2006, outcome was comparable for specialists and the nurse practitioner. This could be due to the change from short-acting to long-acting/mixed local anaesthetic, and the technique for infiltration. The waiting time for surgery reduced from a mean of 16 to 3 weeks. Conclusion. Specialists and the nurse practitioner achieved comparable outcome after open carpal tunnel decompression.