Browse > Article
http://dx.doi.org/10.5999/aps.2020.01732

Open carpal release using local anesthesia without a tourniquet: Does bleeding tendency affect the outcome?  

Lee, Seongwon (Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine)
Oh, Sangho (W-Hospital)
Son, Daegu (Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine)
Publication Information
Archives of Plastic Surgery / v.47, no.6, 2020 , pp. 597-603 More about this Journal
Abstract
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.
Keywords
Carpal tunnel syndrome; Median nerve; Nerve compression syndrome; Hand; Tourniquet;
Citations & Related Records
Times Cited By KSCI : 6  (Citation Analysis)
연도 인용수 순위
1 Wilson KM. Double incision open technique for carpal tunnel release: an alternative to endoscopic release. J Hand Surg Am 1994;19:907-12.   DOI
2 Mackinnon SE. Pathophysiology of nerve compression. Hand Clin 2002;18:231-41.   DOI
3 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.   DOI
4 Sasor SE, Cook JA, Duquette SP, et al. Tourniquet use in wide-awake carpal tunnel release. Hand (N Y) 2020;15:59-63.   DOI
5 Finsen V. Reduced pain when injecting lidocaine. Tidsskr Nor Laegeforen 2017;137:629-30.   DOI
6 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.   DOI
7 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.   DOI
8 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.
9 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.   DOI
10 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.   DOI
11 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.   DOI
12 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.   DOI
13 Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 2000;23:1280-3.   DOI
14 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.   DOI
15 Bromley GS. Minimal-incision open carpal tunnel decompression. J Hand Surg Am 1994;19:119-20.   DOI
16 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.   DOI
17 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.   DOI
18 Shinya K, Lanzetta M, Conolly WB. Risk and complications in endoscopic carpal tunnel release. J Hand Surg Br 1995;20:222-7.   DOI
19 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.
20 Learmonth JR. The principle of decompression in the treatment of certain diseases of peripheral nerves. Surg Clin North Am 1933;13:905-13.
21 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.
22 Corradi M, Paganelli E, Pavesi G. Carpal tunnel syndrome in long-term hemodialyzed patients. J Reconstr Microsurg 1989;5:103-10.   DOI
23 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.   DOI
24 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.   DOI