Regional Anesthesia for Bilateral Carpal Tunnel Release

  • Debra S. Varela, DNP, CRNA Barry University
  • Johanna Newman, DNAP, CRNA Barry University
  • Jorge A. Valdes, DNP, CRNA Florida International University


Carpal Tunnel Syndrome is the most common nerve entrapment neuropathy with over 60% of diagnosed patients presenting with bilateral median nerve involvement.  Bilateral upper extremity surgery presents unique anesthesia challenges, yet surgeons are increasingly interested in performing simultaneous bilateral carpal tunnel release (BCTR) procedures. Regional anesthesia techniques traditionally employed for unilateral hand procedures are impractical, and general anesthesia is expensive and incurs added risk.  A cost effective and efficient anesthesia plan for BCTR is therefore needed. Objective:  Conduct a literature search to support the administration of an efficient and safe anesthesia technique for BCTR utilizing local infiltration and median nerve block.  Methods: Electronic searches were conducted for current pertinent information published in anesthesia, hand surgery and plastic surgery journals within the past 5 years.  Information gathered was assimilated to make an evidence based recommendation for a BCTR anesthesia technique.  Results: BCTR is a more cost effective and time efficient treatment for bilateral carpal tunnel syndrome than a staged unilateral approach.  Local anesthesia with median nerve block with or without sedation is a cost efficient and safe anesthesia strategy for BCTR.

Author Biographies

Debra S. Varela, DNP, CRNA, Barry University

Debra S. Varela, MA, CRNA received her BSN from Missouri Southern State University in 1988, a Masters of Arts in Biology/Physiology from the University of Missouri in Kansas City along with CRNA certification from the Truman Medical Center School of Nurse Anesthesia in 1991.  She is a candidate for the degree of Doctor of Nursing Practice in Anesthesiology through Barry University in Miami Florida.  Debra is a practicing CRNA at a critical access hospital in rural North Central Arkansas, where she specializes in orthopedic and hand surgery.


Johanna Newman, DNAP, CRNA, Barry University

Dr. Johanna Newman is an Assistant Professor of Anesthesiology at Barry University. Dr. Newman received her Bachelors of Science in Nursing from William Paterson University and her Masters of Science in Nurse Anesthesia from Georgetown University. Dr. Newman maintains clinical competence by practicing anesthesia at the various medical facilities in South Florida where she specializes in pediatric anesthesia. Dr. Newman currently serves on various committees on the state and national level. Dr. Newman’s research interest include patient safety, use of simulation to assess clinical competence in nurse anesthesia students, and pediatric anesthesia.

Jorge A. Valdes, DNP, CRNA, Florida International University

Dr. Jorge Valdes is a Clinical Assistant Professor of Anesthesiology at Florida International University in the College of Nursing Health Sciences.  Dr. Valdes’ research focuses is on addiction and provider reentry into practice. Dr. Valdes’ practices at the Miami Medical Center, where his focus is in regional anesthesia and obstetrics. He was recently inducted in the Miami Dade College, Alumni Hall of Fame.


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How to Cite
VARELA, DNP, CRNA, Debra S.; NEWMAN, DNAP, CRNA, Johanna; VALDES, DNP, CRNA, Jorge A.. Regional Anesthesia for Bilateral Carpal Tunnel Release. Anesthesia eJournal, [S.l.], v. 6, p. 1-6, feb. 2018. ISSN 2333-2611. Available at: <>. Date accessed: 19 aug. 2022.


Carpal tunnel syndrome, median nerve block, local anesthesia, and epinephrine