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Wide-Awake Carpal Tunnel Release: Tourniquet vs. No Tourniquet
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, 2R.L. Roudebush VA Medical Center, Indianapolis, IN

Introduction: 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) has been shown to be safe and effective and is gaining popularity. Tourniquet discomfort is a reported downside to wide-awake surgery. Local anesthetic containing epinephrine is an alternative means of achieving hemostasis. The purpose of this study was to review outcomes in wide-awake CTR and to compare tourniquet versus no tourniquet use.
Methods: A retrospective review of all wide-awake, open CTR’s performed from February 2013 – April 2016 were identified and divided into two cohorts: with tourniquet and without tourniquet. Patient demographics, medical comorbidities, anticoagulation status, tobacco use, electromyography findings, operative time, estimated blood loss, complications and post-operative outcomes were analyzed. Statistical analysis was performed using the Student’s t-test.
Results: A total of 304 CTR’s were performed on 246 patients. The majority of patients were male (88.5%) and the mean age at surgery was 59.9 years (range 25.3 to 91.2 years). One hundred patients (32.9%) were diabetic and 92 patients (30.2%) were anticoagulated. Seventy five patients (24.7%) were active smokers. Average pre-operative median nerve motor latency at the wrist was 6.8 ms (range 3.0 to 15.9 ms).

A forearm tourniquet was used for 90 of 304 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 3.16 mL with a tourniquet and 4.25 mL without (p=0.0004).

All other analyzed variables were not statistically significant, including post-operative complications, surgical site infection, or wound healing complications. No patient required re-operation for any reason during the study period.

Overall, 91.8% of patients reported improvement symptoms post-operatively with a mean follow-up time of 3.3 months.
Discussion: 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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