Cargando…

Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial

BACKGROUND: Carpal tunnel syndrome and trigger finger are two of the most common conditions treated by the hand surgeon. During these procedures, a tourniquet is often used to minimize bleeding and improve visualization of the operative field. However, it may be associated with pain and discomfort....

Descripción completa

Detalles Bibliográficos
Autores principales: Saleh, Eli, Saleh, Joseph, Govshievich, Alexander, Ferland-Caron, Geneviève, Lin, Jenny C., Tremblay, Dominique M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032361/
https://www.ncbi.nlm.nih.gov/pubmed/33854860
http://dx.doi.org/10.1097/GOX.0000000000003513
_version_ 1783676204444811264
author Saleh, Eli
Saleh, Joseph
Govshievich, Alexander
Ferland-Caron, Geneviève
Lin, Jenny C.
Tremblay, Dominique M.
author_facet Saleh, Eli
Saleh, Joseph
Govshievich, Alexander
Ferland-Caron, Geneviève
Lin, Jenny C.
Tremblay, Dominique M.
author_sort Saleh, Eli
collection PubMed
description BACKGROUND: Carpal tunnel syndrome and trigger finger are two of the most common conditions treated by the hand surgeon. During these procedures, a tourniquet is often used to minimize bleeding and improve visualization of the operative field. However, it may be associated with pain and discomfort. To date, there are few prospective studies investigating the safety and patient-centered outcomes of tourniquet-free minor hand procedures. METHODS: This is a randomized controlled trial comparing patients undergoing open carpal tunnel or trigger finger release with or without the use of a tourniquet. Perioperative subjective patient experience was investigated for both techniques. This was measured based on a numerical rating scale for pain, anxiety, and overall satisfaction. In addition, this was an equivalence trial in terms of operative time, bleeding scores, and perioperative complication rates. RESULTS: A total of 67 patients were recruited. Both groups were similar with respect to distribution of age, sex, handedness, anti-platelet use, and tobacco use. Median scores for operative time, anxiety, and overall satisfaction were comparable between the 2 groups. With regard to patient discomfort, median scores were significantly higher in the tourniquet group when compared with the no tourniquet group (3.58 versus 1.68, respectively, P = 0.02). Bleeding scores for the tourniquet group were significantly lower than for the no tourniquet group (1.14 versus 1.90, respectively, P = 0.001). CONCLUSIONS: The application of wide awake local anesthesia no tourniquet (WALANT) in minor hand surgery procedures has been shown to decrease tourniquet-associated discomfort, improving perioperative patient experience. Additionally, it demonstrated the noninferiority of the tourniquet-free technique with respect to operative time and the rate of perioperative complications.
format Online
Article
Text
id pubmed-8032361
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-80323612021-04-13 Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial Saleh, Eli Saleh, Joseph Govshievich, Alexander Ferland-Caron, Geneviève Lin, Jenny C. Tremblay, Dominique M. Plast Reconstr Surg Glob Open Hand/Peripheral Nerve BACKGROUND: Carpal tunnel syndrome and trigger finger are two of the most common conditions treated by the hand surgeon. During these procedures, a tourniquet is often used to minimize bleeding and improve visualization of the operative field. However, it may be associated with pain and discomfort. To date, there are few prospective studies investigating the safety and patient-centered outcomes of tourniquet-free minor hand procedures. METHODS: This is a randomized controlled trial comparing patients undergoing open carpal tunnel or trigger finger release with or without the use of a tourniquet. Perioperative subjective patient experience was investigated for both techniques. This was measured based on a numerical rating scale for pain, anxiety, and overall satisfaction. In addition, this was an equivalence trial in terms of operative time, bleeding scores, and perioperative complication rates. RESULTS: A total of 67 patients were recruited. Both groups were similar with respect to distribution of age, sex, handedness, anti-platelet use, and tobacco use. Median scores for operative time, anxiety, and overall satisfaction were comparable between the 2 groups. With regard to patient discomfort, median scores were significantly higher in the tourniquet group when compared with the no tourniquet group (3.58 versus 1.68, respectively, P = 0.02). Bleeding scores for the tourniquet group were significantly lower than for the no tourniquet group (1.14 versus 1.90, respectively, P = 0.001). CONCLUSIONS: The application of wide awake local anesthesia no tourniquet (WALANT) in minor hand surgery procedures has been shown to decrease tourniquet-associated discomfort, improving perioperative patient experience. Additionally, it demonstrated the noninferiority of the tourniquet-free technique with respect to operative time and the rate of perioperative complications. Lippincott Williams & Wilkins 2021-04-08 /pmc/articles/PMC8032361/ /pubmed/33854860 http://dx.doi.org/10.1097/GOX.0000000000003513 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Hand/Peripheral Nerve
Saleh, Eli
Saleh, Joseph
Govshievich, Alexander
Ferland-Caron, Geneviève
Lin, Jenny C.
Tremblay, Dominique M.
Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial
title Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial
title_full Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial
title_fullStr Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial
title_full_unstemmed Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial
title_short Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial
title_sort comparing minor hand procedures performed with or without the use of a tourniquet: a randomized controlled trial
topic Hand/Peripheral Nerve
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032361/
https://www.ncbi.nlm.nih.gov/pubmed/33854860
http://dx.doi.org/10.1097/GOX.0000000000003513
work_keys_str_mv AT saleheli comparingminorhandproceduresperformedwithorwithouttheuseofatourniquetarandomizedcontrolledtrial
AT salehjoseph comparingminorhandproceduresperformedwithorwithouttheuseofatourniquetarandomizedcontrolledtrial
AT govshievichalexander comparingminorhandproceduresperformedwithorwithouttheuseofatourniquetarandomizedcontrolledtrial
AT ferlandcarongenevieve comparingminorhandproceduresperformedwithorwithouttheuseofatourniquetarandomizedcontrolledtrial
AT linjennyc comparingminorhandproceduresperformedwithorwithouttheuseofatourniquetarandomizedcontrolledtrial
AT tremblaydominiquem comparingminorhandproceduresperformedwithorwithouttheuseofatourniquetarandomizedcontrolledtrial