Carpal Tunnel Release without a Tourniquet: A Systematic Review and Meta-Analysis

Abstract

Background: Open carpal tunnel release is commonly performed with the use of a tourniquet. The combination of local anesthetic and epinephrine with a pneumatic tourniquet helps provide clear visualization during decompression of the median nerve. There has been a rapid expansion of literature challenging the use of tourniquets in open carpal tunnel release. Consequently, the local anesthesia/no tourniquet approach has become increasingly popular. The authors evaluated the outcomes of awake open carpal tunnel release with and without a tourniquet. Methods: The authors attempted to identify all relevant studies, regardless of language or publication status. A systematic database search for relevant studies was conducted in MEDLINE, EMBASE, EBSCO, and CENTRAL. Included studies compared patients undergoing awake open carpal tunnel release with and without an arm or forearm tourniquet. Results: Eight studies evaluating 765 patients and 866 hands were included. Open carpal tunnel release with the wide awake, local anesthesia, no tourniquet approach resulted in a 2.14 point reduction on the visual analog scale (95% CI, 1.30 to 2.98; p < 0.001). The procedure was 1.82 minutes faster with the use of a tourniquet (95% CI, –3.26 to –0.39; p = 0.01). There were no significant differences between groups in intraoperative blood loss, surgeon perceived difficulty, and complications. Conclusion: This systematic review found that tourniquet use causes significantly more pain with no significant clinical benefit as compared with using a wide awake, no tourniquet approach in carpal tunnel decompression.

Effect of tourniquet in minor hand surgery on perioperative pain and short-term clinical outcomes: a randomized controlled trial

“…In contrast to our expectations and the results of others, the painful experience of the tourniquet did not affect the overall pain experienced perioperatively nor the patient satisfaction (Olaiya et al, 2020). One possible explanation might be that the pain experienced by the tourniquet did not add to the injection pain already experienced.…”

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

“…Many surgeons use a tourniquet when performing surgical procedures for carpal tunnel syndrome to induce hemostatic effects and to obtain a clear operative field. Recently, Olaiya et al [19] evaluated the outcomes of wide-awake open carpal tunnel release with and without a tourniquet. According to their systemic review and meta-analysis, the use of a tourniquet induces significantly more pain with no significant clinical benefit when compared with the wide-awake technique in which no tourniquet is used in carpal tunnel decompression.…”

Analysis of the Long-Term Outcome in Open Carpal Tunnel Release Surgeries with and without External Neurolysis of Median Nerve, Using Boston Carpal Tunnel Questionnaire (BCTQ)–Hindi Version

“… 6 Zero intra- or postoperative complications reported in our study substantiates the robust safety profile of the standard OCTR. Our wide-awake (local anesthesia) and no tourniquet policy for OCTR received strong support from a recent meta-analysis published by Olaiya et al 33 The paper reported that “tourniquet use causes significantly more pain with no added clinical benefit as compared with using a wide awake, no tourniquet approach in CTR.”…”