Reduced pain seen with limb occlusion tourniquet pressure in carpal tunnel release
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PHOENIX — During a clinical/translational session at the Orthopaedic Research Association Annual Meeting, here, a researcher said in the early postoperative period following open carpal tunnel release surgery, limb occlusion pressure may be associated with reduced pain at the tourniquet site, as well as an overall reduction in the use of pain medication postoperatively compared with standard pneumatic tourniquet pressure.
Haley Goble, BS, who presented findings of the cross-sectional, double-blinded, randomized, control trial, said limb occlusion pressure (LOP) theoretically has an increased safety margin and a decreased risk of complications compared with standard pneumatic tourniquet pressure (STP).
“Our primary findings of this study are that limb occlusion pressure had statistical significance in reducing pain at the tourniquet site compared to standard pneumatic tourniquet pressure. In addition, limb occlusion pressure significantly reduces the quantity of opioid pain medication taken by nearly 50% postoperatively,” Goble said.
She and her colleagues recruited 22 patients into the limb occlusion pressure group and 22 patients into the standard tourniquet pressure group to study the effects of LOP and STP in open carpal tunnel surgery. Researchers used the VAS for pain at the tourniquet site, as well as for overall pain, during the first 2 weeks postoperatively for the primary outcome measure.
The average tourniquet time was 7.72 minutes, which was not statistically different between the LOP and STP groups, according to Goble, who noted average LOP pressure was 190 mm Hg vs. standard tourniquet pressure of 250 mm Hg in open carpel tunnel release.
Concerning pain at the surgical site, which all patients tracked three times per day for 14 days postoperatively, “both groups were observed to have similar pain responses at the surgical site,” Goble said, noting there was no statistically significant difference between the groups.
“LOP does not appear to reduce patient-perceived pain at the surgical site. However, at the tourniquet site, we saw different results,” she said.
From preoperative measures, results showed significantly elevated pain at the tourniquet site in both groups and in the STP group, this pain remained high for about 2 weeks postoperatively.
According to Goble, the differences in pain between the groups corresponded with patient opioid use. She said, not only did the LOP group take significantly less pain medication in the first postoperative week, but “LOP significant reduces the quantity of pain medications taken by almost 50% in the first week after surgery.”
To see if these results are similar on a larger scale, Goble said she and her colleagues are conducting studies like this one of patients undergoing ACL reconstruction and total knee arthroplasty. – by Susan M. Rapp
Reference:
Morehouse H, et al. Paper 177. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 8-11, 2020; Phoenix.
Disclosure: Goble reports no relevant financial disclosures.