Most surgeons use a torniquet for carpal tunnel surgery. A torniquet is large blood pressure type cuff that is tightly applied to the upper arm once the blood has been squeezed out to allow a bloodless field for surgery. Mike was invited to give a number of lectures at the American Association of Hand Surgeons in Los Angeles. It was during one of the other key note lectures that he heard that surgery without a tourniquet is increasingly becoming popular in the United States. A quick survey of his recently operated patients revealed that the tourniquet was often the worst part of the procedure. Mike's anaesthetist mixes a drug called Adrenaline with the local anaesthetic. This has the effect of significantly reducing bleeding during the operation without the need for the uncomfortable tourniquet.