The impact of tourniquet on patient satisfaction in carpal tunnel decompression

Abstract

<jats:title>Abstract</jats:title><jats:p>Release of the transverse carpal ligament can be performed safely under local anesthesia and without the use of tourniquet. There are conflicting reports for the use of tourniquet in carpal tunnel syndrome. The aim of the study was to compare the patient satisfaction with and without tourniquet in patients with carpal tunnel decompression. This was a retrospective study performed in twenty-four patients who underwent bilateral carpal tunnel decompression. All the patients were diagnosed using a combination of clinical history, clinical tests and EMG recordings.</jats:p><jats:p>One side was operated with use of tourniquet and other side without. Patient evaluation measure was used to assess the satisfaction score. A telephonic interview was conducted and patients were asked the questions regarding discomfort caused by tourniquet. The results demonstrated that there was a significant difference in discomfort at the tourniquet site at the time of operation (p&lt;0.00017). Long term, there was no apparent difference in functional outcome of patients operated on with or without tourniquet. There was also no significant difference in subjective sensation, grip or use of hand in patients who underwent carpal tunnel release with or without tourniquet. We conclude that we should not use tourniquet in carpal tunnel decompression.</jats:p>

Comparing the Effects of Two Tourniquet Times on Pain and Knee Range of Motion after Internal Plate Fixation of Tibia Fractures

“…Fan et al [14] found that postoperative pain was more severe among patients who were treated with tourniquet. Liu et al [15], Nagpal et al [16] and Saied et al [17] also reported the same finding while Nakayama and Yoshiya found no significant difference between the postoperative pain intensity of patients in tourniquet and notourniquet groups.…”

“…For instance, Saied and Zyaei assessed the effects of tourniquet use during plate fixation of acute extraarticular tibia fractures and found that tourniquet use was associated with significantly higher levels of postoperative pain [16]. Besides, Konrad et al [33] reported that tourniquet use increased postoperative pain after open reduction and internal fixation of ankle fractures.…”

“…A possible explanation for significant between-group difference regarding knee ROM at first days after surgery and non-significant between-group difference at subsequent days may be tissue repair and regeneration and pain relief over time. It is believed that tourniquet use reduces ROM of joints through inflicting microscopic injuries to muscles, affecting cellular viability, and increasing postoperative pain and edema [16]. Dennis et al [35] also assessed the effects of tourniquet use on the function of lower extremities after knee arthroplasty and found that quadriceps strength in their no-tourniquet group was significantly higher than the tourniquet group.…”

Questioning the use of tourniquets in carpal tunnel surgery and determining ideal level

“…In patients who received tourniquets, mean time with upperarm tourniquet was found as 9.5 minutes (8-11), and mean time with forearm tourniquet was 10.11 (8)(9)(10)(11)(12) minutes. A bloodless surgical area was successfully obtained with both tourniquet methods (Group 1 and 2).…”

“…Nagpal et al reported that patients were discomforted by tourniquets and there were no long-term differences in outcome with or without tourniquets [12].…”