Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial

H J Iqbal, A Doorgakant, N N T Rehmatullah, A Ramavath, P Pidikiti, S Lipscombe

Open carpal tunnel decompression (CTD) is one of the most common procedures in orthopaedics and is routinely performed under local anaesthetic using an arm tourniquet. The use of tourniquet is no longer considered routine by many surgeons.

Methods: We conducted a prospective randomised controlled trial of day case CTD under local anaesthesia. 37 procedures were performed using an arm tourniquet and 36 with adrenaline and local anaesthetic mixture but without tourniquet. Our primary outcome measure was the overall pain and discomfort experienced by patients during the procedure as assessed by the VAS scores. The secondary outcomes were Levine scores and Mini DASH scores.

Results: Patients undergoing carpal tunnel decompression with an arm tourniquet experienced significantly more pain and discomfort (median VAS. 5) as compared with those who had their operation performed without a tourniquet (median VAS. 2.5) (p. 0.003, 95% CI. 0.60 to 2.98). Both tourniquet and no tourniquet groups reported a significant improvement in function after the surgery as assessed by mini-DASH (95% CI. 13 to 25, p. 0.000), Levine SSS (95% CI. 13 to 17, p. 0.000) and Levine FSS questionnaires (95% CI. 4 to 8, p. 0.000).

Conclusion: We conclude that carpal tunnel decompression performed with a tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a tourniquet.