Effect of neuroplasty on different grades of median nerve dysfunction in carpal Tunnel syndrome

All enrolled patients who are not responding to pharmacotherapy after 6 weeks of treatment will undergo median nerve neuroplasty under USG guidance, in Pain Clinic, Department of Anaesthesiology and Critical Care, at the wrist using linear high frequency USG probe. The USG probe will be placed on the anterior aspect of wrist. The nerve will be seen as a single elliptical hyperechoic structure with internal hypochoic circles. USG grading will be done on the basis of cross sectional area of median nerve. Skin above the target will be infiltrated with 0.5ml of 2%Lidocaineto avoid pain due to needle insertion. Insert the needle, 22G and Som in length, using in plane approach from radial side of probe. 3ml solution containing 0.25% Bupivacaine +Triamcinolone(20mg) will be infiltrated around the nerve as real time injection in patients with CTS. Care will be taken to visualize the spread of drug which distend the perineum around the median nerve and to avoid needle penetration of nerve tissue and intravascular injury. All patients will be monitored in recovery room after intervention for 4 hours.