The impact of tourniquet on patient satisfaction in carpal tunnel decompression

Open Medicine ◽  
2007 ◽  
Vol 2 (2) ◽  
pp. 222-226 ◽  
Author(s):  
Kamal Nagpal ◽  
Mohammed Gossiel ◽  
Hari Kumar
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Clinical History ◽  
Apparent Difference ◽  
Significant Difference ◽  
Tunnel Syndrome ◽  
Without Tourniquet ◽  
Time Of Operation ◽  
The Impact

AbstractRelease of the transverse carpal ligament can be performed safely under local anesthesia and without the use of tourniquet. There are conflicting reports for the use of tourniquet in carpal tunnel syndrome. The aim of the study was to compare the patient satisfaction with and without tourniquet in patients with carpal tunnel decompression. This was a retrospective study performed in twenty-four patients who underwent bilateral carpal tunnel decompression. All the patients were diagnosed using a combination of clinical history, clinical tests and EMG recordings.One side was operated with use of tourniquet and other side without. Patient evaluation measure was used to assess the satisfaction score. A telephonic interview was conducted and patients were asked the questions regarding discomfort caused by tourniquet. The results demonstrated that there was a significant difference in discomfort at the tourniquet site at the time of operation (p<0.00017). Long term, there was no apparent difference in functional outcome of patients operated on with or without tourniquet. There was also no significant difference in subjective sensation, grip or use of hand in patients who underwent carpal tunnel release with or without tourniquet. We conclude that we should not use tourniquet in carpal tunnel decompression.

scholarly journals Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation

2017 ◽  
Vol 09 (02) ◽  
pp. 074-079 ◽  
Author(s):  
Nayoung Kim ◽  
Jack Abboudi ◽  
Christopher Jones ◽  
Frederic Liss ◽  
William Kirkpatrick ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Demographic Data ◽  
Syndrome Scale ◽  
Significant Difference ◽  
Tunnel Syndrome ◽  
Without Tourniquet ◽  
Open Carpal Tunnel Release ◽  
Wide Awake

Background Carpal tunnel release (CTR) is the most common surgery of the hand, and interest is growing in performing it under local anesthesia without tourniquet. To better understand differences, we hypothesized that patients undergoing CTR under wide-awake local anesthesia with no tourniquet (WALANT) versus sedation (monitored anesthesia care [MAC]) would not result in a difference in outcome. Methods Consecutive cases of electrodiagnostically confirmed open CTR across multiple surgeons at a single center were prospectively enrolled. Data included demographic data, visual analog scale, Levine-Katz carpal tunnel syndrome scale, QuickDASH questionnaire, customized Likert questionnaire, and complications. Results There were 81 patients enrolled in the WALANT group and 149 patients in the MAC group. There were no reoperations in either group or any epinephrine-related complications in the WALANT group. Disability and symptom scores did not differ significantly between WALANT and sedation groups at 2 weeks or 3 months. Average postoperative QuickDASH, Levine-Katz, and VAS pain scales were the same in both groups. Both groups of patients reported high levels of satisfaction at 91 versus 96% for the WALANT versus MAC groups, respectively (p > 0.05). Patients in each group were likely to request similar anesthesia if they were to undergo surgery again. Conclusion Patients undergoing open CTR experienced similar levels of satisfaction and outcomes with either the WALANT or MAC techniques. There was no statistically significant difference between either group relative to the tested outcome measures. These data should facilitate surgeons and patients' choosing freely between WALANT and MAC techniques relative to complications and outcomes.

The Results of Carpal Tunnel Release: Open Versus Endoscopic Technique

1994 ◽  
Vol 19 (1) ◽  
pp. 14-17 ◽  
Author(s):  
S. BANDE ◽  
L. DE SMET ◽  
G. FABRY
Keyword(s):  
Patient Satisfaction ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Endoscopic Technique ◽  
Open Release ◽  
Significant Difference ◽  
Open Versus ◽  
Portal Technique

We retrospectively compared two similar groups of patients who underwent either endoscopic decompression of the carpal tunnel (single portal technique, 44 patients) or open decompression (58 patients) during 1 year in our department. To find out whether there was any subjective difference between the results of the two techniques, we sent each patient a questionnaire and received a 95% response. No major complications occurred. Three endoscopic decompressions had to be abandoned, and open release was performed. We could not demonstrate any significant difference in relief of symptoms and return to work between the two groups. Patient satisfaction at 6 to 18 months follow-up was high with both techniques.

scholarly journals Tourniquet Use in Wide-Awake Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Sarah E. Sasor ◽  
Julia A. Cook ◽  
Stephen P. Duquette ◽  
Elizabeth A. Lucich ◽  
Adam C. Cohen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Carpal Tunnel ◽  
Local Anesthetic ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Estimated Blood Loss ◽  
Tunnel Syndrome ◽  
Clinically Significant ◽  
Without Tourniquet ◽  
Wide Awake

Background: 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) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss 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 postoperative outcomes between groups.

scholarly journals Improvement of Sleep Quality after Surgical Decompression in Carpal Tunnel Syndrome

2021 ◽  
Author(s):  
Nguyen Le Trung Hieu ◽  
Nguyen Anh Sang ◽  
Nguyen Lam Vuong
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Sleep Quality ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Surgical Decompression ◽  
Poor Sleep ◽  
Tunnel Syndrome ◽  
And Function ◽  
Hand Symptoms ◽  
The Impact

Abstract Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy which can cause severe sleep disturbance. Carpal tunnel release (CTR) is a choice for severe cases, which has shown to improve sleep quality, but the available evidence is limited. This study aimed to investigate the impact of CTR on sleep quality and hand symptoms and functions in patients with CTS. Methods This was a prospective study in 2019–2020 on patients with CTS and poor sleep quality undergoing CTR. Patients were evaluated before and at 1, 3, and 12 months after CTR by the Pittsburgh sleep quality index (PSQI) and Boston carpal tunnel syndrome questionnaires. Results There were 33 patients with 27 females (82%) and a median age of 51 years. The median time of CTS diagnosis and having sleep disorder before CTR were 12 and 6 months, respectively. The outcomes significantly improved after CTR, with the median PSQI and Boston symptom and function scores reduced from 12, 33, and 23 before CTR to 9, 14, and 11 at 1 month; 7, 13, and 9 at 3 months; and 1, 11, and 8 at 12 months postoperatively, respectively. The correlations between the PSQI and Boston symptom and function scores were > 0.6 at all time-points. Conclusions Surgical decompression significantly improves sleep quality and the hand symptoms and functions in patients with CTS. Long-term evaluations are lacking and thus are required in future studies.

Comparison of Patient-Reported Outcomes between Two Different Techniques of Carpal Tunnel Release: Classical Incision versus Minimal Incision

2020 ◽  
Author(s):  
Sajad Heidari ◽  
Alireza Taabbod ◽  
Mahmoud Farzan ◽  
Sadegh Saberi ◽  
Mitra Ashrafi
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel ◽  
Patient Reported Outcomes ◽  
Carpal Tunnel Release ◽  
Symptom Relief ◽  
Visual Analogue Score ◽  
Minimal Incision ◽  
Significant Difference ◽  
Patient Reported ◽  
One Year

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper limb which needs surgery in many cases. Two common surgical incisions for carpal tunnel release (CTR) are classical incision and minimal incision. In this survey, the aim is to compare patient-reported outcomes of these two types of incisions. Methods: In this retrospective study, patients with CTS who underwent two different approaches for CTR (classical or minimal) during one year were included. The diagnosis was confirmed clinically and by electrodiagnostic studies. The patients were categorized into two groups regarding the type of surgery. At the 12-month visit, the patients were assessed for functional outcome, level of the pain, and satisfaction with Quick Disability of Arm, Hand and Shoulder score (QuickDASH), the visual analogue score (VAS) scale, and the scar appearance and symptom relief, respectively. Results: 39 patients were entered in this study, 3 of who had bilateral symptoms. The 42 operated hands were divided into two groups: classical incision group (n = 21) and minimal incision group (n = 21). No significant difference was discovered between the two groups considering age and sex. In addition, no significant difference was found in the variables evaluated between the two groups, except for the higher patient satisfaction with the scar appearance in minimal incision group after 12 months. Conclusion: After a one-year period, the minimal incision procedure had no priority to classical incision procedure, except for higher patient satisfaction considering the scar appearance.

The Effect of Age and Gender upon Symptoms and Surgical Outcomes in Carpal Tunnel Syndrome

2005 ◽  
Vol 30 (6) ◽  
pp. 599-604 ◽  
Author(s):  
J. L. HOBBY ◽  
R. VENKATESH ◽  
P. MOTKUR
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Surgical Outcome ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Age And Gender ◽  
Younger Patients ◽  
Tunnel Syndrome ◽  
And Gender

There is conflicting evidence regarding the effectiveness of carpal tunnel release in older patients. This is a prospective study which evaluates the impact of age and gender upon symptoms, self-reported disability and surgical outcome in a series of 97 patients with carpal tunnel syndrome. Symptom severity, hand function and patient satisfaction were assessed using the Boston Carpal Tunnel Questionnaire and the Patient Evaluation Measure. A statistical correlation of age and gender with symptoms, hand function and surgical outcome was performed with questionnaires administered before open carpal tunnel decompression and 6 months after surgery. Women reported greater pre-operative symptoms and disability than men, but there was no gender-related difference in surgical outcome or patient satisfaction. There was no difference in surgical outcome between patients 60 and 70 years of age and younger patients. The majority of patients over the age of 70 reported an improvement in symptoms and function, but they were less satisfied with their treatment than younger patients. Some patients had problems with persistent numbness and loss of dexterity following surgery. The outcome of carpal tunnel release in terms of improvement in the symptom and functional scores is sufficient to justify surgery in the elderly, but surgical outcomes are less predictable than in younger patients and we recommend that this is explained to them when obtaining consent for surgery.

The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome

2017 ◽  
Vol 22 (03) ◽  
pp. 303-308
Author(s):  
Qian Ying TANG ◽  
Wei Hong LAI ◽  
Shian Chao TAY
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Complete Resolution ◽  
Carpal Tunnel Release ◽  
Patient Reported Outcome ◽  
Dominant Hand ◽  
Hand Dominance ◽  
Significant Difference ◽  
Patient Reported ◽  
Tunnel Syndrome

Background: There is a paucity of studies in published literature that examines the effect of hand dominance on the resolution of symptoms following a carpal tunnel release. The objective of this study is to examine the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome. Methods: Bilateral carpal tunnel release (total 90 open and 84 endoscopic) was performed on 87 patients (11 males, 76 females) presenting with bilateral severe or moderate carpal tunnel syndrome of equal severity. Patient-reported outcome of resolution of symptoms were recorded, with patients followed up until complete resolution of symptoms or last recorded consultation (mean follow-up duration 11.4 months, range 3.1 to 32.4 months). Results: In patients with bilateral severe carpal tunnel syndrome, a larger proportion of non-dominant hand (75.4%) achieved complete resolution compared to dominant hand (72.1%), and did so at a statistically shorter time (mean: 52.3 days) than the dominant hand (mean: 81.0 days). However, there was no statistically significant difference between proportion of patients and time taken before complete resolution of symptoms between dominant and non-dominant hand in patients with bilateral moderate carpal tunnel syndrome. Conclusions: Symptoms in the non-dominant hand resolved faster after carpal tunnel release in patients with severe carpal tunnel syndrome. We postulate that greater daily activity by the dominant hand compared to the non-dominant hand may be a contributing factor to its slower rate of symptoms resolution post-surgically in patients with bilateral severe carpal tunnel syndrome. This effect of hand dominance is not evident in post-surgical patients with moderate carpal tunnel syndrome.

Which Factors Affect the Rate of Surgery Performed in Patients with Carpal Tunnel Syndrome?

2018 ◽  
Vol 23 (04) ◽  
pp. 562-565 ◽  
Author(s):  
Yo-Han Lee ◽  
Jihyeung Kim ◽  
Jaewoo Cho ◽  
Min Ho Lee ◽  
Sohee Oh ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Dominant Hand ◽  
Significant Difference ◽  
Electrophysiologic Test ◽  
Tunnel Syndrome ◽  
Age Over 60

Background: Carpal tunnel release is recommended when patients have positive electrophysiologic test and their symptoms are not resolved in spite of conservative treatment. However, only some of them eventually undergo the surgery. The purposes of this study, therefore, were to evaluate the rate of carpal tunnel release performed among the patients with positive electrophysiologic test, and to identify which factors were associated with the rate of the surgery. Methods: Subjects of this study were 865 wrists of 508 patients (90 males and 418 females) who were diagnosed as carpal tunnel syndrome between January 2013 and December 2016. The diagnosis of carpal tunnel syndrome was confirmed by electrophysiologic test, and only the patients who were followed up for more than 1 year were enrolled in this study. The average age at the time of the electrophysiologic test performed was 61.4 years, and the severity of carpal tunnel syndrome was evaluated according to the Bland scale (Gr 1–6) based on the electrophysiologic test. Whether or not the patients received carpal tunnel release was evaluated at the last follow-up visit. Results: Among the 865 wrists, carpal tunnel release was performed on 528 wrists (61%). Rate of the surgery performed significantly increased in patients with more severe grades on electrophyisiologic test. More patients in female (63.3%) than in male (50.3%) and more patients with age under 60 (67.5%) than age over 60 (57.1%) received the surgery. However, there was no significant difference in the rate of carpal tunnel release according to the bilaterality or dominant hand. Conclusions: The rate of carpal tunnel release among the patients diagnosed and confirmed as carpal tunnel syndrome was not higher than we expected. We should also pay more attention to the patients who did not undergo carpal tunnel release and investigate the reasons why those patients did not undergo surgery.

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

2020 ◽  
Vol 47 (6) ◽  
pp. 597-603
Author(s):  
Seongwon Lee ◽  
Sangho Oh ◽  
Daegu Son
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Medical Records ◽  
Carpal Tunnel Release ◽  
Clinical Results ◽  
Complete Disappearance ◽  
Bleeding Tendency ◽  
Significant Difference ◽  
Tunnel Syndrome ◽  
Preoperative Score

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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