Purpose: According to Duncan’s article in the Journal of Hand Surgery in 1987, 49% of Hand Society members deflated the tourniquet prior to closure of a carpal tunnel incision. The usual reasons for this are to prevent post-operative hematoma, and possible subsequent increase in post-operative pain. We wished to examine if these reasons were valid.

Materials and Methods: We prospectively studied 16 patients (32 hands) who were undergoing bilateral simultaneous open carpal tunnel releases. In each patient, the side that was done first had the tourniquet deflated, and bleeding points coagulated prior to wound closure. The second side was done in the exact same manner, except that the tourniquet was left up until the final dressing was in place, and was then released. The side that was done first was randomized according to the patient’s medical record number. The patient’s pre-operative pain level on each side was measured on a visual analog scale (VAS). At the first post-operative visit (about 10 days post-operatively), their pain score was measured again, and the amount of visible ecchymosis in both limbs was diagrammed. The patterns of ecchymosis were rated as 0 for none, 1 for minimal, 2 for mild, and 3 for moderate. These ten day observations were made blindly as to the method of tourniquet utilization in each hand.

Results: The average VAS pain scores in the hand with the tourniquet deflated first (hemostasis obtained) decreased from 6.6 pre-operatively to 2.2 post-operatively. Similarly, when the tourniquet was left up, the average pain scores decreased from 6.4 pre-operatively to 2.3 post-operatively. These changes in pain level are not statistically different from each other. The average ecchymosis “score” for the hands where the tourniquet was released prior to closure (hemostasis obtained) was 1.0 (minimal), while it was 1.7 (mild) in those in which the tourniquet was left up until the final dressing was placed.

Discussion: In our patients, the amount of post-operative ecchymosis did not correlate with increased post-operative pain after open carpal tunnel release. Without tourniquet deflation and obtaining hemostasis prior to skin closure, there was a slightly increased rate of ecchymosis; however, this did not appear to be detrimental in terms of pain.