Browsing by Author "Duquette, Stephen P."

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    Combined Carpal Tunnel Release and Palmar Fasciectomy for Dupuytren’s Contracture Does Not Increase the Risk for Complex Regional Pain Syndrome
    (Wolters Kluwer, 2018-08) Loewenstein, Scott Nathan; Duquette, Stephen P.; Adkinson, Joshua M.; Surgery, School of Medicine
    Background: Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome (CTS) and Dupuytren’s contracture (DC) results in an increased incidence of Complex Regional Pain Syndrome (CRPS). As a result, many surgeons do not perform surgery for the two conditions concurrently. Our goal was to determine the extent of this association. Methods: We identified all patients undergoing surgical treatment for CTS, DC, or both between April 1982 and March 2017 using the Indiana Network for Patient Care (INPC), a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year post-operative incidence of CRPS were recorded. Results: A total of 51,739 (95.6%) patients underwent carpal tunnel release (CTR) only, 2,103 (3.9%) underwent palmar fasciectomy (PF) only, and 305 (0.6%) underwent concurrent CTR and PF. There was no difference in the likelihood of developing CRPS (p=0.163) between groups. Independent risk factors for developing CRPS were younger age, anxiety, depression, epilepsy, gout, and history of fracture of the radius, ulna, or the carpus. Conclusions: Concurrent CTR and PF is not associated with an increased risk for developing CRPS. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of CRPS after surgery and should be discussed preoperatively as potential risk factors.
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    Tourniquet Use in Wide-Awake Carpal Tunnel Release
    (Sage, 2020-01) Sasor, Sarah E.; Cook, Julia A.; Duquette, Stephen P.; Lucich, Elizabeth A.; Cohen, Adam C.; Wooden, William A.; Tholpady, Sunil S.; Chu, Michael W.; Surgery, School of Medicine
    Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.