Outcomes of the surgical treatment of carpal tunnel syndrome under local anesthesia: comparison of the surgeries with and without tourniquet use

Abstract

Purpose: Carpal tunnel syndrome is the most common upper limb entrapment neuropathy. The current study reviews outcomes in carpal tunnel syndrome surgeries performed with local anesthesia in a procedure room outside the operating room and compares the surgeries with and without tourniquet use. Materials and methods: Patients who underwent carpal tunnel syndrome surgery between June 2019 and January 2023 were retrospectively analyzed. Patients were divided into two groups: with and without tourniquet use. Demographic characteristics, operative time, complications, and outcomes were compared. All patients were examined preoperatively and at postoperative month 3 using the Quick Disabilities of the Arm, Shoulder and Hand scale (QDASH) questionnaire, which measures upper extremity activity and participation restrictions. Results: The study included 119 patients. The operative time was longer in the nontourniquet group than in the tourniquet group, with a statistically significant difference (16.75±2.39 min and 14.47±1.88 min, p<0.001). Bipolar use was higher in the nontourniquet group, with a statistically significant difference (p<0.001). The preoperative QDASH score was statistically similar in both groups (62.58±6.67 and 63.86±6.04, p=0.229). The mean postoperative QDASH score was 4.79±7.65 in the nontourniquet group and 4.24±3.86 in the tourniquet group (p=0.799). Conclusions: Tourniquet use may slightly shorten the operative time and may be more effective in controlling bleeding. However, there was no significant difference between the groups regarding postoperative results. The results indicate that operating with a local anesthesia alone is an effective alternative to tourniquet use and a safe choice.

Keywords

• Carpal tunnel syndrome
• tourniquet
• wide awake hand surgery

Karpal tünel sendromunun lokal anestezi ile yapılan cerrahi tedavisinin sonuçları: turnikeli ve turnikesiz yapılan ameliyatların karşılaştırılması

Abstract

Amaç: Karpal tünel sendromu en sık görülen üst ekstremite tuzak nöropatisidir. Bu çalışma, ameliyathane dışında bir işlem odasında lokal anestezi ile yapılan karpal tünel sendromu ameliyatlarının sonuçlarını gözden geçirmekte ve turnikeli ve turnikesiz ameliyatları karşılaştırmaktadır. Giriş ve yöntem: Haziran 2019 ile Ocak 2023 tarihleri arasında karpal tünel sendromu ameliyatı geçiren hastalar retrospektif olarak incelendi. Hastalar turnikeli ve turnikesiz olmak üzere iki gruba ayrıldı. Demografik özellikler, operasyon süresi, komplikasyonlar ve sonuçlar karşılaştırıldı. Tüm hastalar ameliyat öncesi ve ameliyat sonrası 3. ayda, üst ekstremite aktivitesini ve katılım kısıtlamalarını ölçen Hızlı Kol, Omuz ve El Engelliliği ölçeği (QDASH) anketi kullanılarak değerlendirildi. Bulgular: Çalışmaya 119 hasta dahil edildi. Ameliyat süresi turnike olmayan grupta istatistiksel olarak anlamlı derecede daha uzundu (16,75±2,39 dk ve 14,47±1,88 dk, p<0,001). Bipolar kullanımı turnike olmayan grupta istatistiksel olarak anlamlı derecede daha yüksekti (p<0.001). Preoperatif QDASH skoru her iki grupta istatistiksel olarak benzerdi (62,58±6,67 ve 63,86±6,04, p=0,229). Ameliyat sonrası ortalama QDASH skoru turnikesiz grupta 4,79±7,65, turnikeli grupta 4,24±3,86 idi (p=0,799). Sonuç: Turnike kullanımı ameliyat süresini biraz kısaltabilir ve kanama kontrolünde daha etkili olabilir. Ancak ameliyat sonrası sonuçlar açısından gruplar arasında anlamlı fark yoktu. Bu, tek başına lokal anestezik ile ameliyatın turnike kullanımına güvenli ve etkili bir alternatif olduğunu düşündürmektedir.

Keywords

• Karpal tünel sendromu
• turnike
• uyanık el cerrahisi

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