Carpal Tunnel Syndrome Clinical Trial
Official title:
Comparing Open Carpal Tunnel or Trigger Finger Release Procedures Performed Under Local Anesthesia With or Without the Use of a Tourniquet: A Randomized Controlled Trial
Background: Trigger finger and carpal tunnel syndrome 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
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. This is an
equivalence trial in terms of operative time, bleeding scores and peri-operative complication
rates. In addition, peri-operative subjective patient experience will be investigated for
both techniques. This will be measured based on a numerical rating scale (NRS) for pain,
anxiety and overall satisfaction. The primary goal of this study is to to determine the
efficacy and patient preference of the the differing techniques.
This is a randomized controlled trial comparing patients undergoing open carpal tunnel or
trigger finger release with or without the use of a tourniquet. This will be a parallel study
by design where the allocation ratio between the two groups will be set to be 1:1.
Patients are to be recruited on the day of the procedure. Upon arrival, they will be
presented with the research project and given the information pamphlet and consent forms.
Sufficient time to read these documents will be allocated.
For the purpose of this RCT, the same volume and concentration of the solution will be
injected in the surgical site prior to entering the operating room, thereby allowing
epinephrine to full take effect. The solution used by the hand surgeons will include 8 cc of
2% xylocaine with epinephrine mixed with 3 cc of 0.5% Marcaine with epinephrine. Eight
millilitres will be used for the CT releases and 4 millilitres for the TF releases. Once in
the room, the patient's arm will be disinfected and draped in a similar fashion, and surgery
will proceed without inflation of the tourniquet. A system will be implemented so that before
patient A's surgery begins, patient B will be injected in a separate room. By the time
patient B's surgery begins, a minimum of 30 minutes will have elapsed since his injection.
Other than the differences in tourniquet use, all other procedure-specific elements will be
identical, namely the size and location of the incision, the surgical technique, skin
closure, type of dressing, rehabilitation and post-operative follow-up.
The primary outcome of interest is peri-operative patient experience. The aim is to
demonstrate the superiority of the no tourniquet technique with respect to the patients'
subjective experience peri-operatively. This will be measured based on a numerical rating
scale (NRS) for pain, anxiety and overall satisfaction. As secondary outcomes, operative
time, bleeding control and short-term complication rates will be looked at and compared
between the two groups.
To achieve statistical significance, at least 31 patients will be needed in each group to
show a minimal decrease of 33% on the NRS scales evaluation of the postoperative pain and
overall experience with an α error of 0,05 and a power of 80%.
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