Bypassing the Tourniquet: Clinical, Operational, and Economic Outcomes of Wide-Awake Local Anesthesia Versus Traditional Methods for Carpal Tunnel Syndrome and Trigger Finger

Background: Carpal tunnel syndrome and trigger finger are common hand conditions generally treated with local anesthesia and a pneumatic tourniquet. However, tourniquets commonly induce ischemic pain, requiring intravenous sedation or general anesthesia. The wide-awake local anesthesia no tourniquet technique (using lidocaine with epinephrine) avoids the use of tourniquets and sedation. Purpose: To critically review the existing literature that compares the clinical, workflow, and cost-benefit of the wide-awake local anesthesia no tourniquet procedure to local anesthesia with a pneumatic tourniquet for carpal tunnel syndrome release and trigger finger release. Methods: We reviewed the literature and extracted comparative data on pain, complication rates, time, and institutional cost. Results: The wide-awake local anesthesia no tourniquet technique has equal or improved clinical results to local anesthesia with a pneumatic tourniquet. This technique eliminates tourniquet ischemia and associated pain and opioid use. This approach simplifies the surgical procedure by moving it to procedure rooms, which leads to a 50% reduction in room turnover. Financially, it leads to institutional cost savings of 52% to greater than 70% per case. Complications are limited and statistically similar. And it facilitates intraoperative motor testing to ensure full anatomical release. Conclusion: Wide-awake local anesthesia no tourniquet is a safe, effective and economical paradigm. Tourniquets and main operating theatre use are avoided to increase efficiency and reduce costs, thus improving patient access to this common surgery.