Prophylactic Antibiotics Not Always Necessary For Carpal Tunnel Release Surgery
Repetitive strain injuries are occurring more frequently with today's lifestyles, but the most common one that affects the hand or arm is carpal tunnel syndrome. According to statistics, every year, one million adults in the United States are diagnosed with carpal tunnel syndrome and around 200,000 surgeries to correct the problem are performed each year.

Carpal tunnel syndrome occurs when the median nerve, the nerve that runs from your forearm through your wrist and into your hand, becomes compressed as it passes through the carpal tunnel, in the wrist. The compression is most often due to inflammation in the tendon, because of constant use and wear of the tendon by repetitive motions.

Usually, surgery is not the first step approach to dealing with carpal tunnel syndrome. Nonsurgical management, such as taking anti-inflammatory drugs, using splints to immobilize the wrist, and taking a break from the tasks that may be making the situation worse are the usually first treatments. However, if these don't work, then surgery may be necessary. Carpal tunnel surgery is like all surgery, meaning that it has risks as any other, including the risk of infection. Although the risk of infection is low with carpal tunnel surgery, it is important to understand how it happens and to learn how to prevent it, if possible.

The authors of this article found that not much research had been done regarding how often infections occurred at the site of carpal tunnel surgery and if preventative (prophylactic) antibiotics would help reduce the rate. To address this, the authors reviewed surgical cases involving carpal tunnel syndrome that took place over a 20-month period. They were looking at both superficial infections and those that occurred deep in the incision.

Researchers found 3,003 cases (2,067 women) to review, performed by 98 surgeons in 11 medical centers. This group was dubbed Group A. The patients ranged in age from 48 to 66 years and there were 546 patients who had diabetes. Using the files, the researchers looked for information on infections: if the patients received antibiotics before the surgery, how many patients developed infections, other health issues among the patients, and how the infections were treated. To clarify the infection types, superficial infections were defined as infections that occurred within a month of surgery and were restricted to the skin or superficial, subcutaneous, tissue. Deep incisional infections were infections that occurred within 30 days, but came from deeper within the wound, may have caused the wound to open, or caused symptoms of infection, such as fever, pain, and/or tenderness at the site.

The first part of the study involved determining who had received prophylactic antibiotics and this rate varied considerably between the facilities. In one hospital, only 12.3 percent of the patients received the prophylactic antibiotics, while in another, 89.9 percent did. The surgeons also varied as to whether they would prescribe them. One surgeon never prescribed the antibiotics (0 percent) while another did for all patients (100 percent). This resulted in 2,336 cases, which were put into Group B.

In group A, 2,974 of the cases were done as outpatients, the remaining were in the hospital. Of all the 3003 patients, there were 11 surgical site infections : four were in an organ or the space below the tissue and seven were superficial or deep. Three of the 11 patients had diabetes. One of these patients had extra surgery done at the same time as the carpal tunnel release, on the thumb, so the infection could have begun in that area instead of the carpal tunnel. All the infections occurred in patients who were operated on as outpatients.

In group B, 1,419 (of 3,003) patients received prophylactic antibiotics, 917 did not and researchers could not be sure if 617 did or didn't. Among the patients who did receive antibiotics, five developed infections. Six patients who didn't take antibiotics developed infections too.

The researchers concluded that the overall infection rate after this type of surgery was low and more severe infections, in the organs, for example, was even lower than originally thought and reported. While using antibiotics before surgery is a good idea for some types of surgery, such as on the colon, it doesn't seem to be necessary for carpal tunnel syndrome, because there were no significant differences in infection rates between patients who had received these antibiotics and those who didn't.
Neil G. Harness, MD, et al. Rate of Infection After Carpal Tunnel Release Surgery and Effect of Antibiotic Prophylaxis. In Journal of Hand Surgery. February 2010. Vol. 35. No. 2. Pp. 189-196.