De Quervain’s Tendon Release

Anesthesia Implications

Position: Supine, one arm extended, one arm tucked, Bed turned 90 degrees
Time: 5-30 min (very short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
Tourniquet Use: Yes
Blocks: Axillary, Bier, Supraclavicular

Approach – Anesthesia is typically completed under MAC with local injection or a general anesthetic with an LMA. This procedure can also be completed under local anesthetic with light sedation. For any of the approaches, a peripheral nerve block can be administered. Since MAC is the most common approach, that is what will be primarily covered in this post.

Local Anesthetic Injection – Make sure to give propofol prior to the local anesthetic injection. This will be one of the most stimulating parts of the procedure.

Tourniquet Pain – After the local anesthetic injection, the primary pain will be from the tourniquet, so assess regularly for this and give propofol and/or fentanyl as needed. Tourniquet pain will still be there with a Bier Block, but absent with an axillary or supraclavicular peripheral nerve block.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Tourniquet (general considerations): Antibiotics should be administered prior to tourniquet inflation. Tourniquet pain usually begins 45-60 minutes after inflation and is unresponsive to regional anesthesia and analgesics. Upper extremity pressure should be set to approximately 70-90 mmHg above systolic blood pressure (SBP). Lower extremity tourniquet pressure should be set to approximately 2 times SBP. Upon tourniquet release, there will be increases in End-tidal CO2 and metabolic acidosis, while decreases will be seen in core body temperature, blood pressure, and mixed venous oxygen saturation (SvO2)

Surgical release of the De Quervain’s tendon is done to reduce the pressure in the wrist. The goal of a surgical release is to “release” the tendon sheath that wraps around the base of the thumb, relieving pressure and friction and allowing movement. The surgeon makes an incision in the wrist near the base of the thumb. Thereafter, the tissue or sheaths over the swollen tendons are opened to relieve the tendon and the compressed nerves, thereby alleviating the associated pain.