Minimising Tourniquet Time and Post-operative Pain During Carpal Tunnel Decompression

Background Pain and discomfort at the tourniquet and wound site are recognised complications of carpal tunnel surgery. Studies have shown that longer tourniquet times lead to increased pain, local and systematic complications. We hypothesise that minimising the intraoperative tourniquet time will reduce post-operative pain and complications. Objective Our aim is to present the results of our novel operative technique for carpal tunnel decompression which minimises tourniquet time. Method The study represented a prospective case series in which 55 consecutive and unselected patients with positive nerve conduction study results were operated on by a single surgeon at a single hospital site over a period of 12 months. The patients filled in a questionnaire based on a visual analogue score (VAS) (1-10) for pain at (1) first presentation at the clinic, (2) recovery in theatre post-operatively and (3) on discharge from care at 12 weeks post-operatively. Questions included the perception of pain at the tourniquet site and at the wound site. Results  A total of 55 (female 39 and male 16) patients participated in the study. The average tourniquet time was 5 minutes 50 seconds. 98% of patients had a VAS of 1 at both the wound and tourniquet site post-operatively. One patent had a score of 3 at the tourniquet site. Eleven patients had undergone contralateral carpal tunnel decompression surgery. Of the remaining 43 patients, all said they would have the other side operated on in the same way. Conclusion  We have demonstrated a safe and efficient technique to reduce post-operative pain by minimising tourniquet inflation time. Our patient cohort experienced no significant complications and minimal pain post-operatively.