Subscribe to RSS

DOI: 10.5999/aps.2020.01732
Open carpal release using local anesthesia without a tourniquet: Does bleeding tendency affect the outcome?
Authors
This article was presented at the PRS Korea on November 11, 2018, in Seoul, Korea.
Background The aim of this study was to analyze the clinical results of minimal single palmar-incision carpal tunnel release without a tourniquet.
Methods We reviewed the medical records of 75 patients (90 cases of carpal tunnel syndrome) who underwent minimal single-palmar incision carpal tunnel release without a tourniquet from June 2010 to January 2018. Ten patients had a bleeding tendency. We compared the preoperative and postoperative Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores. We also analyzed outcomes and complications according to the presence of a bleeding tendency.
Results In all cases, there was a complete disappearance or marked improvement in symptoms within 6 months, with no recurrence. The postoperative BCTQ score showed a significant improvement compared to the preoperative score, and no statistically significant difference in BCTQ scores was detected according to the presence of a bleeding tendency.
Conclusions Carpal tunnel release without a tourniquet using a minimal single palmar incision is effective and reliable. This technique prevents unnecessary pain associated with the tourniquet and is especially helpful in patients with a bleeding tendency or those treated with hemodialysis.
Publication History
Received: 01 September 2020
Accepted: 04 October 2019
Article published online:
25 March 2022
© 2020. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
REFERENCES
- 1 Learmonth JR. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am 1933; 13: 905-13
- 2 Sur YJ, Song SW, Rhee SK. et al. Carpal tunnel release with minimal single palmar incision. J Korean Soc Surg Hand 2008; 13: 79-85
- 3 Nagpal K, Gossiel M, Kumar H. The impact of tourniquet on patient satisfaction in carpal tunnel decompression. Cent Eur J Med 2007; 2: 222-6
- 4 Corradi M, Paganelli E, Pavesi G. Carpal tunnel syndrome in long-term hemodialyzed patients. J Reconstr Microsurg 1989; 5: 103-10
- 5 Tulipan JE, Kim N, Abboudi J. et al. Open carpal tunnel release outcomes: performed wide awake versus with sedation. J Hand Microsurg 2017; 9: 74-9
- 6 Davison PG, Cobb T, Lalonde DH. The patient’s perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study. Hand (N Y) 2013; 8: 47-53
- 7 Lalonde D, Martin A. Tumescent local anesthesia for hand surgery: improved results, cost effectiveness, and wide-awake patient satisfaction. Arch Plast Surg 2014; 41: 312-6
- 8 Levine DW, Simmons BP, Koris MJ. et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75: 1585-92
- 9 Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000; 23: 1280-3
- 10 van den Broeke LR, Theuvenet WJ, van Wingerden JJ. Effectiveness of mini-open carpal tunnel release: an outcome study. Arch Plast Surg 2019; 46: 350-8
- 11 Castillo R, Sheth K, Babigian A. et al. Recurrent carpal tunnel syndrome associated with extension of flexor digitorum muscle bellies into the carpal tunnel: a case series. Arch Plast Surg 2018; 45: 474-8
- 12 Varitimidis SE, Herndon JH, Sotereanos DG. Failed endoscopic carpal tunnel release: operative findings and results of open revision surgery. J Hand Surg Br 1999; 24: 465-7
- 13 Shinya K, Lanzetta M, Conolly WB. Risk and complications in endoscopic carpal tunnel release. J Hand Surg Br 1995; 20: 222-7
- 14 Bromley GS. Minimal-incision open carpal tunnel decompression. J Hand Surg Am 1994; 19: 119-20
- 15 Yoo HM, Lee KS, Kim JS. et al. Surgical treatment of carpal tunnel syndrome through a minimal incision on the distal wrist crease: an anatomical and clinical study. Arch Plast Surg 2015; 42: 327-33
- 16 Biyani A, Downes EM. An open twin incision technique of carpal tunnel decompression with reduced incidence of scar tenderness. J Hand Surg Br 1993; 18: 331-4
- 17 Wilson KM. Double incision open technique for carpal tunnel release: an alternative to endoscopic release. J Hand Surg Am 1994; 19: 907-12
- 18 Mackinnon SE. Pathophysiology of nerve compression. Hand Clin 2002; 18: 231-41
- 19 Olaiya OR, Alagabi AM, Mbuagbaw L. et al. Carpal tunnel release without a tourniquet: a systematic review and meta-analysis. Plast Reconstr Surg 2020; 145: 737-44
- 20 Sasor SE, Cook JA, Duquette SP. et al. Tourniquet use in wide-awake carpal tunnel release. Hand (N Y) 2020; 15: 59-63
- 21 Finsen V. Reduced pain when injecting lidocaine. Tidsskr Nor Laegeforen 2017; 137: 629-30
- 22 Quttainah A, Carlsen L, Voice S. et al. Ketamine-diazepam protocol for intravenous sedation: the cosmetic surgery hospital experience. Can J Plast Surg 2004; 12: 141-3
- 23 Semer NB, Goldberg NH, Cuono CB. Upper extremity entrapment neuropathy and tourniquet use in patients undergoing hemodialysis. J Hand Surg Am 1989; 14: 897-900
- 24 Al-Benna S, Nano PG, El-Enin H. Extended open-carpal tunnel release in renal dialysis patients. Saudi J Kidney Dis Transpl 2012; 23: 1181-7