Tourniquet Use in Wide-Awake Carpal Tunnel Release

Sasor, Sarah E.; Cook, Julia A.; Duquette, Stephen; Lucich, Elizabeth A; Cohen, Adam S.; Wooden, William A.; Tholpady, Sunil S.; Chu, Michael

doi:10.1177/1558944718787853

Cited by 16 publications

(18 citation statements)

References 35 publications

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“…As the WALANT technique has been used in hand surgery, it has become a safe and effective alternative to carpal tunnel release [20]. The authors administered a sedative immediately before injecting local anesthesia, whereas sedation is not allowed in the WALANT technique.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Oh²,

Son

2020

Arch Plast Surg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Lee

Oh²,

Son

2020

Arch Plast Surg

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“…4 However, to the authors' knowledge, there is no systematic analysis specifically deals with endoscopic CTR with WALANT, although numerous studies assessed WALANT for open CTR with good results. 5,6 We report a prospective case series assessing the patient and surgeon experience, as well as complications with WALANT for single-port endoscopic CTR.…”

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confidence: 99%

Endoscopic Carpal Tunnel Release Using Wide-Awake Anesthesia

Urban

Meuli‐Simmen

et al. 2020

Journal of Hand Surgery Global Online

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We report on patient and surgeon experience after single-port endoscopic carpal tunnel release (CTR) using wide-awake local anesthesia no tourniquet (WALANT) technique. Methods: From July to November 2018, patients undergoing endoscopic CTR with WALANT were prospectively included. Follow-up was 3 months. Patient ratings before, during, and after the operation were collected. We recorded the surgeon's experience during surgery compared with the endoscopic CTR under local anesthesia with exsanguination and tourniquet. Complications were defined as nerve injury, infection, or the need for revision surgery. Results: The cohort consisted of 20 patients (24 wrists). All patients except one reported a complete or substantial decrease of symptoms. The 2 surgeons involved judged the procedure to be technically more demanding owing to impaired visualization (33%) caused by increased bleeding and edema in the operative field. There was one conversion from endoscopic to open surgery. Conclusions: We recommend starting single-port endoscopic CTR using WALANT with a noninflated tourniquet in place for use when necessary. Type of study/level of evidence: Therapeutic IV.

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“…Keywords: ropivacaine, lidocaine, carpal tunnel release Carpal tunnel syndrome (CTS) is one of the most frequently diagnosed upper extremety compression neuropathies [1], being described as an entrapment of the median nerve at the level of the wrist [2]. In the general population, the prevalence of CTS is up to 5%.…”

mentioning

confidence: 99%

“…In the general population, the prevalence of CTS is up to 5%. The main pathophysiologic mechanisms involved in the median nerve compression are the impairment of the epineural blood flow and axonal conduction [1]. The distribution of the median nerve is represented by the thumb, index, middle finger, and the radial side of the ring finger, so the presenting symptoms are hand pain, numbness, paresthesias and weakness in the palmar, radial hand.…”

mentioning

confidence: 99%

“…The recommened first-line treatments are the antiinflammatory medications and steroid injections, but the majority of patients do not respond to this therapeutical plan [1] and the surgical release of the flexor retinaculum is indicated [4], reducing the pressure of the medial nerve [2]. The surgical intervention can be performed under local or general anesthetic, with or without a tourniquet [5], being recommended to all the patients with moderate to severe CTS.…”

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confidence: 99%

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