Tourniquet vs. Epinephrine in Wide-Awake Carpal Tunnel Release
Sarah E. Sasor, MD1, Stephen P. Duquette, MD1, Elizabeth A. Lucich, BS1, Julia A. Cook, BS1, Adam C. Cohen, MD2, William A. Wooden, MD1, Sunil S. Tholpady, MD PhD1, Michael W. Chu, MD1.
1Indiana University, Indianapolis, IN, USA, 2Richard L. Roudebush VA Hospital, Indianapolis, IN, USA.
Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use.
Wide-awake, open CTR’s performed from February 2013-April 2016 were retrospectively reviewed. Patients were divided into two cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Statistical analysis was performed.
A total of 304 CTR’s were performed on 246 patients. The majority of patients were male (88.5%) and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic and 92 patients (30.2%) were anticoagulated. Seventy five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTR’s (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without (p=0.0029). Estimated blood loss was 3.16mL with a tourniquet and 4.25mL without (p=0.0004). All other analyzed outcomes were not statistically significant.
Operative time was statistically longer and EBL was statistically less with tourniquet use but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low and there were no major differences in post-operative outcomes between groups.
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