Carpal Tunnel Release without a Tourniquet: A Systematic Review and Meta-Analysis
| Autor: | Oluwatobi R. Olaiya, Awwal M Alagabi, Lawrence Mbuagbaw, Mark H. McRae |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Epinephrine
Decompression medicine.drug_class Visual analogue scale Blood Loss Surgical 030230 surgery 03 medical and health sciences 0302 clinical medicine Forearm Medicine Humans Vasoconstrictor Agents Local anesthesia Wakefulness Pain Measurement Tourniquet Pain Postoperative business.industry Local anesthetic Tourniquets equipment and supplies Decompression Surgical Carpal Tunnel Syndrome Median nerve Median Nerve body regions surgical procedures operative medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Anesthesia Meta-analysis Practice Guidelines as Topic Surgery business |
| Zdroj: | Plastic and reconstructive surgery. 145(3) |
| ISSN: | 1529-4242 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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