Bilateral Versus Staged Carpal Tunnel Release

There were two low strength studies (Fehringer 2002, Nesbitt 2006) which looked at simultaneous and staged endoscopic carpal tunnel releases. There were no studies that met our inclusion criteria which evaluated open release. The results of these studies were conflicting. For example, grip strength in short term follow-up was better in the staged group, but return to work was faster in the simultaneous group. Patient-specific factors, such as quality of life, non-employment work, care-giving, family and community responsibilities were not addressed. Both studies were limited in that there was no randomization of treatment protocols. Patients selected simultaneous or staged procedures, and both groups were satisfied with their choices.  At 6 month follow up, there was no difference between the two groups.
 
Because no studies comparing simultaneous versus staged procedures for open release were considered, there are no data to support concurrent or sequential bilateral open carpal tunnel releases. This does not constitute a mandate that bilateral simultaneous carpal tunnel releases should be performed endoscopically. 
 
Implications of two versus one surgical experience such as two anesthetics, total analgesic consumption, costs of two OR and perioperative nursing unit visits were not addressed.