Methods
Quervain’s disease, Pain, Quervain, carpal ganglion cyst (dorsal), coldness, numbness, pain, infection, diabetes, tightness, skin redness, dyslipidemia, bleeding diathesis, trauma
TRIGGER FINGER, STERILE, ADVERSE EFFECTS, INFILTRATED, DEEP VEIN THROMBOSIS, QUERVAIN, SKIN REDNESS, DISEASES, BLEEDING DIATHESIS, DYSLIPIDEMIA, DIABETES, ADVERSE EVENTS, MINOR, INFECTION, CARPAL TUNNEL SYNDROME, SKIN, MAY, PERIPHERAL VASCULAR DISEASE, HYPERTENSION, PERIPHERAL NEUROPATHY
A double-blinded randomized control trial was conducted at Ramathibodi Hospital from July to December 2019 and June 2020 to May 2021. Patients older than 20 years of age, with an RTP less than 250 mmHg, and who were diagnosed with de Quervain’s disease, trigger finger, carpal tunnel syndrome or carpal ganglion cyst (dorsal) were included. Patients with bleeding diathesis and contraindications for tourniquets (peripheral vascular disease, deep vein thrombosis, severe trauma, infection and peripheral neuropathy) [The demographic parameters of the patients, including sex, age, body weight, height, arm circumference (mid-point between shoulder and elbow joint), systolic blood pressure, LOP and RTP, were collected. Underlying diseases such as hypertension, diabetes and dyslipidemia were also recorded. The type of minor hand operation was also classified.Sample size determination was based on mean differences of visual analog scale (VAS) compared between LOP and standard tourniquet. Adding 20 percent of loss to follow up resulting in 116 patients to be included [The LOP was measured for all the patients using automatic LOP measurement equipment (Zimmer A.T.S. 4000, Zimmer Surgical, Inc., Ohio, USA) (Fig. Automatic LOP measurement equipment (ZIMMER A.T.S. 4000)Tourniquet application guidelines were made to control the confounding factors that produced incapable results. The size of the tourniquet was determined by width of the cuff is more than half of arm diameter. Skin under the cuff was protected by 2 layers of 4-inch webril bandage. The cuff was applied on the upper arm which is widest part of the limb to allow as much tissue as possible to lie between the cuff and any nerves or vascular structures susceptible to damage. LOP pulse sensor was attached to the patient’s finger on the limb that the tourniquet has been applied. The corresponding LOP button on the equipment was started for LOP determination. The equipment calculated and displayed the LOP and RTP on the monitor screen approximately within 30 s then pulse sensor was detached from the patient’s finger.After the operative field was prepared with a sterile technique, 1% lidocaine without adrenaline was infiltrated over the incision site before tourniquet inflation, 2 ml for trigger finger and de Quervain’s release and 5 ml for carpal tunnel release and dorsal carpal ganglion excision. Limb was elevated and 3-inch elastic bandage was exsanguinated from fingers to proximal forearm. Tourniquet pressure was applied to the patient by assigned staff who opened the envelope. RTP was applied to the patients in the RTP group, and 250 mmHg was applied to the patients in the control group. The surgeons, well-trained Orthopaedic resident, was not informed about the amount of pressure applied to the patient.During the perioperative period, the total tourniquet time was noted. The patient was instructed to inform staff when pain or discomfort (tightness or tense) occurred at the tourniquet site. Time of pain or discomfort began (time to developed pain) were documented. Pain and discomfort were assessed using VAS separately (0–100; 0 = no pain/discomfort, 100 = worst possible pain/discomfort).Tourniquet was deflated after wound closure and bandage. The surgeon was asked to complete a questionnaire to evaluate the quality and their satisfaction with the surgical field during the operation. The quality of the bloodless and motionless fields was scored as 1 = poor, 2 = fair, 3 = satisfied, and 4 = very satisfied. A poor field was defined as blood or motion occurring and making the operation impossible; a fair field was defined as blood or motion occurring but not significantly disturbing the operation; a satisfactory field was defined as blood or motion occurring with no disturbance to the operation; and a very satisfactory field had no blood or motion occurring. All adverse effects at the tourniquet site after the operation such as coldness, numbness and skin redness were also noted in the questionnaire. One week after the operation, pain, discomfort and adverse events were also monitored.