Surgery on Carpal Tunnel Syndrome - Releasing the tourniquet

Authors of this publication investigated whether letting down the tourniquet prior to closure, following carpal tunnel release, decreases the amount of post operative ecchymosis (bruising) and post operative pain.

18 patients underwent bilateral simultaneous open carpal tunnel release (36 hands in total), with a mean age of 47 years.
Each patient had one hand dressed whilst the tourniquet was still up, however on the other side; the tourniquet was released to obtain haemostasis (clot formation) prior to closure. The wound was then dressed.

The surgical procedure was identical from one side to the other, as well as the method of closure and dressing type and application.
Recordings of the patients pre operative and post operative pain scores were taken, as well as an ecchymosis score 10 days post operation.

Results showed all patients obtained complete relief of numbness in both hands by their first post operative visit. They also revealed that no post operative complications had occurred.

Authors of this study concluded that there was significant evidence to demonstrate a difference between releasing the tourniquet prior to closure or post closure of the wound.
However, they found letting down the tourniquet prior to closure, bears no advantages in terms of pain or haemostasis, it actually increases surgical time unnecessarily.

Mike Hayton however, avoids using a painful tourniquet during his carpal tunnel releases. The local anaesthetic Mike infiltrates contains adrenaline which reduces bleeding at the operative site, thus removing the need for a tourniquet. The surgery can be performed very simply with the minimum of discomfort to his patients.

Douglas T. Hutchinson. Angela A. Wang
Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, USA