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

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.