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Carpal Tunnel Release without a Tourniquet: A Systematic Review and Meta-Analysis.
Plast Reconstr Surg. 2020 03; 145(3):737-744.PR

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.

Authors+Show Affiliations

Hamilton and Toronto, Ontario, Canada From the Michael G. DeGroote School of Medicine, the Department of Health Research Methods, Evidence and Impact, and the Division of Plastic Surgery, Department of Surgery, McMaster University; and the Faculty of Health, York University.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32097317

Citation

Olaiya, Oluwatobi R., et al. "Carpal Tunnel Release Without a Tourniquet: a Systematic Review and Meta-Analysis." Plastic and Reconstructive Surgery, vol. 145, no. 3, 2020, pp. 737-744.
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(3):737-744.
Olaiya, O. R., Alagabi, A. M., Mbuagbaw, L., & McRae, M. H. (2020). Carpal Tunnel Release without a Tourniquet: A Systematic Review and Meta-Analysis. Plastic and Reconstructive Surgery, 145(3), 737-744. https://doi.org/10.1097/PRS.0000000000006549
Olaiya OR, et al. Carpal Tunnel Release Without a Tourniquet: a Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2020;145(3):737-744. PubMed PMID: 32097317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carpal Tunnel Release without a Tourniquet: A Systematic Review and Meta-Analysis. AU - Olaiya,Oluwatobi R, AU - Alagabi,Awwal M, AU - Mbuagbaw,Lawrence, AU - McRae,Mark H, PY - 2020/2/26/entrez PY - 2020/2/26/pubmed PY - 2020/6/26/medline SP - 737 EP - 744 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 145 IS - 3 N2 - 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. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/32097317/Carpal_Tunnel_Release_without_a_Tourniquet:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://Insights.ovid.com/pubmed?pmid=32097317 DB - PRIME DP - Unbound Medicine ER -