Upper extremity tourniquet effects in carpal tunnel release

Nitz, Arthur J.; Dobner, Joseph J.

doi:10.1016/s0363-5023(89)80011-5

Cited by 38 publications

(11 citation statements)

References 22 publications

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“…A number of factors have been implicated in tourniquet related nerve damage including longer durations of tourniquet application [28] and higher tourniquet pressure gradients [45,47]. Studies performed prior to the use of lower pressures in tourniquets demonstrated a higher incidence of neuromuscular dysfunction [51]. Tourniquet related nerve complications exist on a spectrum from minor transient loss of function to permanent irreversible damage.…”

Section: Painmentioning

confidence: 99%

Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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Tourniquets are compressive devices that occlude venous and arterial blood flow to limbs and are commonly used in upper limb surgery. With the potential risk of complications, there is some debate as to whether tourniquets should continue to be routinely used. In this review, we first look at the different designs, principles, and practical considerations associated with the use of tourniquets in the upper limb. The modern pneumatic tourniquet has many design features that enhance its safety profile. Current literature suggests that the risk of tourniquet-related complications can be significantly reduced by selecting cuff inflation pressures based on the limb occlusion pressure, and by a better understanding of the actual level of pressure within the soft tissue, and the effects of cuff width and contour. The evidence behind tourniquet time, placement, and limb exsanguination is also discussed as well as special considerations in patients with diabetes mellitus, hypertension, vascular calcification, sickle cell disease and obesity. We also provide an evidence-based review of the variety of local and systemic complications that may arise from the use of upper limb tourniquets including pain, leakage, and nerve, muscle, and skin injuries. The evidence in the literature suggests that upper limb tourniquets are beneficial in promoting optimum surgical conditions and modern tourniquet use is associated with a low rate of adverse events. With the improvement in knowledge and technology, the incidence of adverse events should continue to decrease. We recommend the use of tourniquets in upper limb surgery where no contraindications exist.

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Section: Painmentioning

confidence: 99%

Tourniquet Use in Upper Limb Surgery

Oragui

Parsons

White

et al. 2010

Hand (New York, N,Y.)

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“…They described the use of epinephrine and bipolar cautery to dispense with the tourniquet. Nitz and Dobner, 24 using electromyography, showed that denervation occurred in the cervical and upper extremity muscles in 77% of patients in whom a tourniquet was used during carpal tunnel release. These findings indicate that upper extremity tourniquet application results in subclinical, temporary changes in the muscles of the forearm, probably on the basis of nerve changes and degeneration.…”

Section: Discussionmentioning

confidence: 99%

Carpal tunnel release without a tourniquet: a simple local anesthesia technique

Modi¹,

Jajodia²,

Suh³

2008

Current Orthopaedic Practice

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“…Prospective studies of meniscectomies with 45 min tourniquet application demonstrate electromyographic abnormalities consistent with denervation of motor units in comparison to a group without tourniquet. Additionally, in a prospective study regarding revisions of carpal tunnel syndromes significant denervations by using a tourniquet were described [23]. A possible route to such a permanent functional loss has been described in the rat optic nerve fibers [26].…”

Section: V M Mmentioning

confidence: 99%

“…One reason might be the iatrogenic damage due to the lateral approach and fibular osteotomy [19]. On the other hand, the clinical use of a tourniquet although very common in the operative setting of orthopedic surgery, has been shown to be responsible for nerve damage [9,23]. Even if this functional loss appears to be subclinical in most of the cases [6], such neuromuscular 16Yo [6,12,18,19,25].…”

Section: Introductionmentioning

confidence: 99%

On the applicability of two different stimulation techniques for intra‐operative peroneal nerve conduction testing

Nebelung¹,

Wissel²,

Awiszus³

2001

Journal Orthopaedic Research

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Dysfunction of the peroneal nerve is an important complication of knee surgery. We compared two monitoring procedures of peroneal nerve function during a standardized operation, a closing wedge high tibial osteotomy. For two types of stimulation the evoked compound motor unit action potentials (CMAPs) were recorded on the tibialis anterior muscle. We used direct perineural electrical Stimulation of the common peroneal nerve distal to the cuff (dCMAPs) after nerve identification in the surgical field. Additionally, magnetic stimulation of the sacral plexus proximal to the cuff (pCMAPs) was performed. It was found that dCMAPs were recorded during almost one hour of tourniquet time whereas the pCMAPs were blocked after 25-30 min in 9 out of 11 cases. On the other hand, the CMAP obtained after proximal stimulation exhibited a latency shift with tourniquet yielding an indicator of ischaemic changes present beneath and distal to the tourniquet cuff. In conclusion, different applicabilities of both stimulation techniques under tourniquet conditions were demonstrated.

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Upper extremity tourniquet effects in carpal tunnel release

Cited by 38 publications

References 22 publications

Tourniquet Use in Upper Limb Surgery

Tourniquet Use in Upper Limb Surgery

Carpal tunnel release without a tourniquet: a simple local anesthesia technique

On the applicability of two different stimulation techniques for intra‐operative peroneal nerve conduction testing

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