Manual Brachial Artery Compression as an Adjunct for Intraoperative Hemostasis During Carpal Tunnel Release

BACKGROUND AND OBJECTIVES: Carpal tunnel release (CTR) is typically a straightforward procedure, and major bleeding is uncommon. However, minor oozing may occasionally interfere with visualization during critical steps. We describe a simple adjunctive maneuver using manual brachial artery compression for temporary control of arterial inflow during CTR. METHODS: This retrospective study describes a consecutive series of 55 patients who underwent CTR under local anesthesia with epinephrine. Manual compression of the brachial artery was applied intermittently to modulate arterial inflow during critical surgical steps. Operative findings and postoperative complications were evaluated. Intraoperative discomfort was retrospectively assessed from nursing records. In a subset of 26 cases with operative video recordings, compression duration and intraoperative bleeding control were evaluated using video review and a 5-point Likert scale by 2 surgical team members. RESULTS: Manual brachial artery compression was applied without interrupting the surgical workflow and provided temporary control of arterial inflow during critical surgical steps. Among the 26 video-analyzed cases, the median total compression time was 23 minutes (range, 13-38 minutes) and the median maximum continuous compression interval was 13 minutes (range, 8-23 minutes). No evaluations were rated ≤3 on the 5-point Likert scale by either evaluator. No documented intraoperative discomfort, distal ischemia, vascular injury, postoperative hematoma, or other complications were identified. CONCLUSION: Manual brachial artery compression is a simple and reproducible adjunctive maneuver that may be useful for temporary control of bleeding during CTR when additional intraoperative hemostatic control is desired.