xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06040840</url>
    </required_header>
    <id_info>
      <org_study_id>2023/02</org_study_id>
      <nct_id>NCT06040840</nct_id>
    </id_info>
    <brief_title>WALANT Versus Axillary Brachial Plexus Block in Carpal Tunnel Release</brief_title>
    <acronym>WALAB</acronym>
    <official_title>WALANT Versus Axillary Brachial Plexus Block in Carpal Tunnel Release: a Non-inferiority Randomized Controlled Trial</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>CMC Ambroise Paré</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>CMC Ambroise Paré</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Carpal tunnel syndrome (CTS) is a common medical condition that remains one of the most&#xD;
        frequently reported forms of median nerve compression. Surgical procedure is a treatment&#xD;
        option for CTS. For this surgery of the upper extremity, regional anesthesia (RA) is the&#xD;
        strategy that should be systematically preferred because it is associated with shorter&#xD;
        postanesthetic care and less pain compared to general anesthesia. Multiple approaches to&#xD;
        block the brachial plexus are available for the surgery of the upper extremity below the&#xD;
        elbow, but the axillary block (BAX) remains the most common approach as it is associated with&#xD;
        low side effects.&#xD;
  &#xD;
        One of the most significant recent advances in the surgery of the upper extremity has been&#xD;
        the emergence of Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique. WALANT is an&#xD;
        infiltration technique of a local anesthetic (LA) (lidocaine) and a hemostatic agent&#xD;
        (epinephrine) directly into the operative site to induce anesthesia and hemostasis in the&#xD;
        area of the surgical procedure to provide conditions suitable for hand surgery without&#xD;
        sedation and tourniquet. Given its effectiveness and low side effects, WALANT could be a&#xD;
        technique of choice in ambulatory surgery.&#xD;
  &#xD;
        The main objective of this non-inferiority, prospective, randomized, open-label,&#xD;
        parallel-group controlled trial is to assess the efficacy of WALANT technique compared to BAX&#xD;
        in carpal tunnel release (CTR).&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Randomization will be performed using an external Interactive Web Response System. Subjects&#xD;
        will be randomly assigned (1:1) in permuted blocks of different sizes, to have either BAX&#xD;
        (Control group) or WALANT (Interventional group). A stratification of the randomization will&#xD;
        be planned according to the Sex.&#xD;
  &#xD;
        In the BAX group (usual technique), axillary brachial plexus block will be performed. In the&#xD;
        WALANT group (experimental technique), local anesthesia will be performed. The Peripheral&#xD;
        nerve blocks (PNBs) will be performed by a physician not involved in the peri-operative&#xD;
        assessment. Care providers and outcomes assessors will be blinded to group allocation.&#xD;
  &#xD;
        After obtaining venous access and placement of standard monitors, patients will be&#xD;
        administered oxygen 2 L/min via nasal prongs. Thirty minutes before surgery, an experienced&#xD;
        anesthesiologist will perform the regional blocks guided by ultrasound (Sonosite Export,&#xD;
        Bothell, USA) using an ultrasound needle (Ultraplex 360°, B Braun, Melsungen, Germany) as&#xD;
        follow:&#xD;
  &#xD;
          -  In the BAX group, patients will be placed in a supine position with their arm abducted&#xD;
             to 90°. The ultrasound probe will be placed to obtain a transverse image of the axillary&#xD;
             artery at the level of the conjoint tendon of the latissimus dorsi and teres major&#xD;
             muscles. With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun,&#xD;
             Melsungen, Germany) will be advanced to achieve a spread of lidocaine (10mg/ml) around&#xD;
             the musculocutaneous, radial, median and ulnar nerves. 30 ml of the solution will be&#xD;
             used to achieve the BAX.&#xD;
  &#xD;
          -  In the WALANT group, patients will be placed in a supine position. Solution for local&#xD;
             anesthesia will be prepared using 20 ml of lidocaine (10mg/ml) with epinephrine (0.005&#xD;
             mg/ml), 17 ml of saline solution and 3 ml of 8.4% sodium bicarbonate. The ultrasound&#xD;
             probe will be placed to obtain a transverse image of the median nerve at the wrist. With&#xD;
             an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun, Melsungen,&#xD;
             Germany) will be advanced to achieve a spread of 5 ml of the solution posterior and then&#xD;
             anterior to the median nerve under the annular carpal ligament. Then the ultrasound&#xD;
             probe will be placed to obtain a longitudinal image of the median nerve at the wrist.&#xD;
             With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun,&#xD;
             Melsungen, Germany) will be advanced to achieve a spread of 15 ml of the solution&#xD;
             anterior to the median nerve towards the carpal tunnel. At last, a local infiltration&#xD;
             with 5 ml of the solution will be performed around the surgical incision.&#xD;
  &#xD;
        Upon completion of the blocks, patients will be transferred to the operating room.&#xD;
  &#xD;
        In the operating room, a pneumatic tourniquet will be placed on the upper arm in all patients&#xD;
        and will be inflated in patients of &quot;BAX&quot; group only. In case of pain or discomfort, an&#xD;
        anesthetist blinded to treatment arm will decide on the need for an alternative anesthetic&#xD;
        technique.&#xD;
  &#xD;
        In ward:&#xD;
  &#xD;
          -  Postoperative analgesia protocol: systematic per os analgesia with paracetamol (1 g, 4&#xD;
             times a day) and ibuprofen (400 mg, 3 times a day)&#xD;
  &#xD;
          -  Mobilization of patient&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">November 1, 2023</start_date>
    <completion_date type="Anticipated">May 1, 2025</completion_date>
    <primary_completion_date type="Anticipated">May 1, 2025</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Other</primary_purpose>
      <masking>Double (Care Provider, Outcomes Assessor)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Regional anesthesia success</measure>
      <time_frame>2 hours</time_frame>
      <description>Need (or not) for additional anesthetic procedure during surgery: analgesics, sedation, general anesthesia, local anesthetics</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Surgery duration</measure>
      <time_frame>2 hours</time_frame>
      <description>Time (in minutes) between the skin incision and the wound dressing procedure.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Length of hospital stay</measure>
      <time_frame>24 hours</time_frame>
      <description>Time (in minutes) between ward admission and discharge.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Discharge criteria assessed by PADSS</measure>
      <time_frame>24 hours</time_frame>
      <description>Time (in minutes) between the regional anesthesia and the ability to discharge defined by the modified Post Anesthesia Discharge Scoring System (PADSS) who achieve a score of 9 or more.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Patient satisfaction assessed by EVAN-LR self-reported questionnaire</measure>
      <time_frame>24 hours</time_frame>
      <description>EVAN-LR self-reported questionnaire comprising 19 items structured in five dimensions, depending on their content: Attention (4 items), Information (5 items), Discomfort (4 items), Waiting (2 items), and Pain (4 items). Each item is linearly transformed to a 0-100 scale, with 100 indicating the best possible level of satisfaction and 0 the worst.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Postoperative pain at the surgical site assessed by VRS</measure>
      <time_frame>24 hours</time_frame>
      <description>Maximum postoperative pain at the surgical site will be assessed at Day-0 et at Day-1 using a Verbal Rating Scale (VRS) ranging from 0 to 10 (0=no pain, 10=worst possible pain).</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Surgical site bleeding</measure>
      <time_frame>2 hours</time_frame>
      <description>Surgeon's clear-field satisfactory score: 1=bloodless, 2=little blood, 3=bloody field but performable, 4=bloody field</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Rate of complications</measure>
      <time_frame>24 hours</time_frame>
      <description>Incidence of complications related to RA procedure: vascular puncture, paresthesia, local anesthetic systemic toxicity</description>
    </secondary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">130</enrollment>
    <condition>Carpal Tunnel Syndrome</condition>
    <arm_group>
      <arm_group_label>BAX group</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>Axillary brachial plexus block + Tourniquet</description>
    </arm_group>
    <arm_group>
      <arm_group_label>WALANT group</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Wide Awake Local Anesthesia No Tourniquet</description>
    </arm_group>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>BAX</intervention_name>
      <description>Injection of 30 mL of lidocaine (10 mg/ml) around the median, radial, ulnar and musculocutaneous nerves.</description>
      <arm_group_label>BAX group</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>Tourniquet</intervention_name>
      <description>Inflation pressure 75 to 100 mmHg above the patient's systolic blood pressure.</description>
      <arm_group_label>BAX group</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Drug</intervention_type>
      <intervention_name>Lidocaine</intervention_name>
      <description>Axillary block with Lidocaine (10 mg/ml).</description>
      <arm_group_label>BAX group</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>WALANT</intervention_name>
      <description>Preparation of a mixture of 20 ml of lidocaine (10 mg/ml) with epinephrine (0.005 mg/ml) + 3 ml Na bicarbonate (84 mg/ml) + 17 ml sterile normal saline.&#xD;
  The ultrasound probe will be placed to obtain a transverse image of the median nerve at the wrist. With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun, Melsungen, Germany) will be advanced to achieve a spread of 5 ml of the solution posterior and then anterior to the median nerve under the annular carpal ligament.&#xD;
  Then the ultrasound probe will be placed to obtain a longitudinal image of the median nerve at the wrist. With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun, Melsungen, Germany) will be advanced to achieve a spread of 15 ml of the solution anterior to the median nerve towards the carpal tunnel.&#xD;
  At last, a local infiltration with 5 ml of the solution will be performed around the surgical incision.</description>
      <arm_group_label>WALANT group</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Drug</intervention_type>
      <intervention_name>Lidocaine + Epinephrine</intervention_name>
      <description>WALANT technique with lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine.</description>
      <arm_group_label>WALANT group</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Patients undergoing endoscopic carpal tunnel release&#xD;
  &#xD;
            -  Consent for participation&#xD;
  &#xD;
            -  Affiliation to a social security system&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Contraindication for regional anesthesia (truncal neuropathy, infection at the&#xD;
               puncture site, coagulation disorder, …)&#xD;
  &#xD;
            -  Contraindication to any drugs used in the protocol (paracetamol, ketoprofen, propofol,&#xD;
               lidocaine, epinephrine)&#xD;
  &#xD;
            -  Chronic pain syndrome&#xD;
  &#xD;
            -  Preoperative Anxiety&#xD;
  &#xD;
            -  Pregnant or breastfeeding women&#xD;
  &#xD;
            -  Patients under protection of the adults (guardianship, curators or safeguard of&#xD;
               justice)&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>N/A</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_contact>
      <last_name>Marie VIRTOS, MD</last_name>
      <phone>0562132997</phone>
      <phone_ext>+33</phone_ext>
      <email>marie.virtos@gmail.com</email>
    </overall_contact>
    <location>
      <facility>
        <name>Clinique Médipôle Garonne</name>
        <address>
          <city>Toulouse</city>
          <state>Haute-Garonne</state>
          <zip>31036</zip>
          <country>France</country>
        </address>
      </facility>
      <contact>
        <last_name>Philippe MARTY, MD</last_name>
        <email>philippemarty@hotmail.com</email>
      </contact>
      <investigator>
        <last_name>Marie VIRTOS, MD</last_name>
        <role>Principal Investigator</role>
      </investigator>
    </location>
    <location_countries>
      <country>France</country>
    </location_countries>
    <verification_date>September 2023</verification_date>
    <study_first_submitted>September 7, 2023</study_first_submitted>
    <study_first_submitted_qc>September 14, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">September 18, 2023</study_first_posted>
    <last_update_submitted>September 14, 2023</last_update_submitted>
    <last_update_submitted_qc>September 14, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 18, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor</responsible_party_type>
    </responsible_party>
    <keyword>WALANT</keyword>
    <keyword>Axillary block</keyword>
    <keyword>Regional anesthesia</keyword>
    <keyword>Tourniquet</keyword>
    <keyword>Carpal Tunnel Release</keyword>
    <keyword>Postoperative analgesia</keyword>
    <keyword>Perioperative patient satisfaction</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Carpal Tunnel Syndrome</mesh_term>
    </condition_browse>
    <intervention_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Lidocaine</mesh_term>
      <mesh_term>Epinephrine</mesh_term>
    </intervention_browse>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06040840
  org study id: 2023/02
  nct id: NCT06040840
  lead sponsor: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  Carpal tunnel syndrome (CTS) is a common medical condition that remains one of the most
        frequently reported forms of median nerve compression. Surgical procedure is a treatment
        option for CTS. For this surgery of the upper extremity, regional anesthesia (RA) is the
        strategy that should be systematically preferred because it is associated with shorter
        postanesthetic care and less pain compared to general anesthesia. Multiple approaches to
        block the brachial plexus are available for the surgery of the upper extremity below the
        elbow, but the axillary block (BAX) remains the most common approach as it is associated with
        low side effects.
  
        One of the most significant recent advances in the surgery of the upper extremity has been
        the emergence of Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique. WALANT is an
        infiltration technique of a local anesthetic (LA) (lidocaine) and a hemostatic agent
        (epinephrine) directly into the operative site to induce anesthesia and hemostasis in the
        area of the surgical procedure to provide conditions suitable for hand surgery without
        sedation and tourniquet. Given its effectiveness and low side effects, WALANT could be a
        technique of choice in ambulatory surgery.
  
        The main objective of this non-inferiority, prospective, randomized, open-label,
        parallel-group controlled trial is to assess the efficacy of WALANT technique compared to BAX
        in carpal tunnel release (CTR).
  Randomization will be performed using an external Interactive Web Response System. Subjects
        will be randomly assigned (1:1) in permuted blocks of different sizes, to have either BAX
        (Control group) or WALANT (Interventional group). A stratification of the randomization will
        be planned according to the Sex.
  
        In the BAX group (usual technique), axillary brachial plexus block will be performed. In the
        WALANT group (experimental technique), local anesthesia will be performed. The Peripheral
        nerve blocks (PNBs) will be performed by a physician not involved in the peri-operative
        assessment. Care providers and outcomes assessors will be blinded to group allocation.
  
        After obtaining venous access and placement of standard monitors, patients will be
        administered oxygen 2 L/min via nasal prongs. Thirty minutes before surgery, an experienced
        anesthesiologist will perform the regional blocks guided by ultrasound (Sonosite Export,
        Bothell, USA) using an ultrasound needle (Ultraplex 360°, B Braun, Melsungen, Germany) as
        follow:
  
          -  In the BAX group, patients will be placed in a supine position with their arm abducted
             to 90°. The ultrasound probe will be placed to obtain a transverse image of the axillary
             artery at the level of the conjoint tendon of the latissimus dorsi and teres major
             muscles. With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun,
             Melsungen, Germany) will be advanced to achieve a spread of lidocaine (10mg/ml) around
             the musculocutaneous, radial, median and ulnar nerves. 30 ml of the solution will be
             used to achieve the BAX.
  
          -  In the WALANT group, patients will be placed in a supine position. Solution for local
             anesthesia will be prepared using 20 ml of lidocaine (10mg/ml) with epinephrine (0.005
             mg/ml), 17 ml of saline solution and 3 ml of 8.4% sodium bicarbonate. The ultrasound
             probe will be placed to obtain a transverse image of the median nerve at the wrist. With
             an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun, Melsungen,
             Germany) will be advanced to achieve a spread of 5 ml of the solution posterior and then
             anterior to the median nerve under the annular carpal ligament. Then the ultrasound
             probe will be placed to obtain a longitudinal image of the median nerve at the wrist.
             With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun,
             Melsungen, Germany) will be advanced to achieve a spread of 15 ml of the solution
             anterior to the median nerve towards the carpal tunnel. At last, a local infiltration
             with 5 ml of the solution will be performed around the surgical incision.
  
        Upon completion of the blocks, patients will be transferred to the operating room.
  
        In the operating room, a pneumatic tourniquet will be placed on the upper arm in all patients
        and will be inflated in patients of "BAX" group only. In case of pain or discomfort, an
        anesthetist blinded to treatment arm will decide on the need for an alternative anesthetic
        technique.
  
        In ward:
  
          -  Postoperative analgesia protocol: systematic per os analgesia with paracetamol (1 g, 4
             times a day) and ibuprofen (400 mg, 3 times a day)
  
          -  Mobilization of patient
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Other
  masking: Double (Care Provider, Outcomes Assessor)
  measure: Regional anesthesia success
  time frame: 2 hours
  description: Need (or not) for additional anesthetic procedure during surgery: analgesics, sedation, general anesthesia, local anesthetics
  measure: Surgery duration
  time frame: 2 hours
  description: Time (in minutes) between the skin incision and the wound dressing procedure.
  measure: Length of hospital stay
  time frame: 24 hours
  description: Time (in minutes) between ward admission and discharge.
  measure: Discharge criteria assessed by PADSS
  time frame: 24 hours
  description: Time (in minutes) between the regional anesthesia and the ability to discharge defined by the modified Post Anesthesia Discharge Scoring System (PADSS) who achieve a score of 9 or more.
  measure: Patient satisfaction assessed by EVAN-LR self-reported questionnaire
  time frame: 24 hours
  description: EVAN-LR self-reported questionnaire comprising 19 items structured in five dimensions, depending on their content: Attention (4 items), Information (5 items), Discomfort (4 items), Waiting (2 items), and Pain (4 items). Each item is linearly transformed to a 0-100 scale, with 100 indicating the best possible level of satisfaction and 0 the worst.
  measure: Postoperative pain at the surgical site assessed by VRS
  time frame: 24 hours
  description: Maximum postoperative pain at the surgical site will be assessed at Day-0 et at Day-1 using a Verbal Rating Scale (VRS) ranging from 0 to 10 (0=no pain, 10=worst possible pain).
  measure: Surgical site bleeding
  time frame: 2 hours
  description: Surgeon's clear-field satisfactory score: 1=bloodless, 2=little blood, 3=bloody field but performable, 4=bloody field
  measure: Rate of complications
  time frame: 24 hours
  description: Incidence of complications related to RA procedure: vascular puncture, paresthesia, local anesthetic systemic toxicity
  arm group label: BAX group
  arm group type: Active Comparator
  description: Axillary brachial plexus block + Tourniquet
  arm group label: WALANT group
  arm group type: Experimental
  description: Wide Awake Local Anesthesia No Tourniquet
  intervention type: Procedure
  intervention name: BAX
  description: Injection of 30 mL of lidocaine (10 mg/ml) around the median, radial, ulnar and musculocutaneous nerves.
  arm group label: BAX group
  intervention type: Procedure
  intervention name: Tourniquet
  description: Inflation pressure 75 to 100 mmHg above the patient's systolic blood pressure.
  arm group label: BAX group
  intervention type: Drug
  intervention name: Lidocaine
  description: Axillary block with Lidocaine (10 mg/ml).
  arm group label: BAX group
  intervention type: Procedure
  intervention name: WALANT
  description: Preparation of a mixture of 20 ml of lidocaine (10 mg/ml) with epinephrine (0.005 mg/ml) + 3 ml Na bicarbonate (84 mg/ml) + 17 ml sterile normal saline.
  The ultrasound probe will be placed to obtain a transverse image of the median nerve at the wrist. With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun, Melsungen, Germany) will be advanced to achieve a spread of 5 ml of the solution posterior and then anterior to the median nerve under the annular carpal ligament.
  Then the ultrasound probe will be placed to obtain a longitudinal image of the median nerve at the wrist. With an in-plane technique, a 50mm ultrasound needle (Ultraplex 360°, B Braun, Melsungen, Germany) will be advanced to achieve a spread of 15 ml of the solution anterior to the median nerve towards the carpal tunnel.
  At last, a local infiltration with 5 ml of the solution will be performed around the surgical incision.
  arm group label: WALANT group
  intervention type: Drug
  intervention name: Lidocaine + Epinephrine
  description: WALANT technique with lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine.
  arm group label: WALANT group
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: N/A
  healthy volunteers: No
  last name: Marie VIRTOS, MD
  phone: 0562132997
  phone ext: +33
  email: marie.virtos@gmail.com
  facility: 
  contact: 
  investigator: 
  country: France
  responsible party type: Sponsor
  mesh term: Carpal Tunnel Syndrome
  mesh term: Lidocaine
  mesh term: Epinephrine