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Tourniquet Does Not Affect Long-term Outcomes in Minor Hand Surgery: A Randomized Controlled Trial.

Saskia F de Roo1,2, Joris S Teunissen2, Matthieu J C M Rutten3,4

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Tourniquet use during carpal tunnel release or trigger finger release surgery did not affect long-term outcomes or complications. Patient outcomes and scar tissue formation were similar with or without a tourniquet.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Patient Outcomes Research

Background:

  • Surgeons frequently use tourniquets for minor hand procedures like carpal tunnel release (CTR) and trigger finger release (TFR).
  • The long-term impact of tourniquet use on patient outcomes and complication rates remains unclear.
  • Patient discomfort is a potential drawback of tourniquet application.

Purpose of the Study:

  • To compare patient-reported outcomes one year after CTR or TFR performed under local anesthesia, with or without a tourniquet.
  • To evaluate secondary outcomes including patient satisfaction, scar tissue formation (via ultrasound), and postoperative complications.

Main Methods:

  • 163 patients undergoing open CTR or TFR under local anesthesia were enrolled between May 2019 and May 2020.
  • Patient-reported outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) and Boston Carpal Tunnel Questionnaires at baseline and 3, 6, and 12 months postoperatively.
  • Ultrasound was used at 6 months to measure scar tissue thickness around the median nerve in CTR patients.

Main Results:

  • 142 patients were included in the final analysis.
  • Both groups showed significant improvements in QDASH and Boston Carpal Tunnel Questionnaire scores within the first 3 months, with sustained improvement at 12 months.
  • No significant differences were observed between the tourniquet and no-tourniquet groups in terms of clinical outcomes, scar tissue thickness, or complication rates (32% overall, none requiring reoperation).

Conclusions:

  • Tourniquet application during carpal tunnel release or trigger finger release does not appear to influence long-term clinical outcomes, scar tissue development, or complication rates.
  • The decision to use a tourniquet should be a shared decision between the surgeon and the patient.
  • This study supports the use of local anesthesia without a tourniquet for these procedures, based on shared decision-making.