Carpal Tunnel With Local Anesthesia Versus WALANT
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Published:
Jun 25, 2022
Keywords:
Carpal tunnel, carpal tunnel decompression, WALANT, local anesthesia, tourniquet
Main Article Content
Abstract
Objective: Surgeries with the WALANT technique have recently become popular. The main advantage of this technique is that it avoids using the tourniquet and eliminates the discomfort it generates. We hypothesize that carpal tunnel decompression with local anesthesia and a pneumatic tourniquet, performed by an experienced surgeon in a short surgical time, allows us to obtain similar outcomes to the WALANT technique surgery.
Materials and Methods: We designed a prospective clinical comparative cohort study. We included twenty-three patients (30 hands) with carpal tunnel syndrome. Two groups of patients were randomized. Group 1 consisted of patients operated on with local anesthesia, and Group 2 included those operated on with the WALANT technique. We carried out a statistical analysis.
Results: All the variables showed statistically significant differences concerning the preoperative values for the two groups. Regarding the relationship between those two groups, the functional outcomes of pain and degree of postoperative satisfaction did not show statistically significant differences.
Conclusions: In our study, carpal tunnel decompression performed with local anesthesia with a tourniquet and those achieved with the WALANT technique had similar outcomes. In the hands of experienced surgeons, local anesthesia with a tourniquet may be sufficient to perform the procedure, thus avoiding the few but complex complications of epinephrine.
Materials and Methods: We designed a prospective clinical comparative cohort study. We included twenty-three patients (30 hands) with carpal tunnel syndrome. Two groups of patients were randomized. Group 1 consisted of patients operated on with local anesthesia, and Group 2 included those operated on with the WALANT technique. We carried out a statistical analysis.
Results: All the variables showed statistically significant differences concerning the preoperative values for the two groups. Regarding the relationship between those two groups, the functional outcomes of pain and degree of postoperative satisfaction did not show statistically significant differences.
Conclusions: In our study, carpal tunnel decompression performed with local anesthesia with a tourniquet and those achieved with the WALANT technique had similar outcomes. In the hands of experienced surgeons, local anesthesia with a tourniquet may be sufficient to perform the procedure, thus avoiding the few but complex complications of epinephrine.
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How to Cite
Gallucci, G., Rosa, Y., Brandariz, R., Cerrutti, W., & Tanoira, I. (2022). Carpal Tunnel With Local Anesthesia Versus WALANT . Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(3), 335-340. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1430
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Clinical Research
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References
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2. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005;30(5):1061-7. https://doi.org/10.1016/j.jhsa.2005.05.006
3. Braithwaite BD, Robinson GJ, Burge PD. Haemostasis during carpal tunnel release under local anaesthesia: a
controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br 1993;18(12):184-6. https//doi.
org/10.1016/0266-7681(93)90103-m
4. Hutchinson DT, Mc Clinton MA. Upper extremity tourniquet tolerance. J Hand Surg 1993;18(2):206-10.
https://doi.org/10.1016/0363-5023(93)90347-6
5. Maury A, Roy W. A prospective, randomized, controlled trial of forearm versus upper arm tourniquet tolerance. J Hand Surg 2002;27(4):359-60. https://doi.org/10.1054/jhsb.2002.0787
6. Gibson M. Outpatient carpal tunnel decompression without tourniquet: a simple local anaesthetic technique. Ann R Coll Surg Engl 1990;72(6):408-9. PMID: 2241063
7. Koegst WH, Wölfle O, Thoele K, Sauerbier M. [The “wide awake approach” in hand surgery: a comfortable
anaesthesia method without a tourniquet]. Handchir Mikrochir Plast Chir 2011;43(3):175-80. https://doi.org/10.1055/s-0031-1280762 [En alemán]
8. Leinberry CF, Rivlin M, Maltenfort M, Beredjiklian P, Matzon JL, Ilyas AM, et al. Treatment of carpal tunnel
syndrome by members of the American Society for Surgery of the Hand: a 25-year perspective. J Hand Surg Am
2012;37(10):1997-2003.e3. https://doi.org/10.1016/j.jhsa.2012.07.016
9. Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery
in the main operating room versus the ambulatory setting in Canada. Hand (NY) 2007;2(4):173-8. https://doi.org/10.1007/s11552-007-9043-5
10. Rhee PC, Fischer MM, Rhee LS, McMillan H, Johnson AE. Cost Savings and Patient Experiences of a ClinicBased, Wide-Awake Hand Surgery Program at a Military Medical Center: A critical analysis of the first 100
procedures. J Hand Surg Am 2017;42(3):e139-e147. https://doi.org/10.1016/j.jhsa.2016.11.019
11. Alter TH, Warrender WJ, Liss FE, Ilyas AM. A cost analysis of carpal tunnel release surgery performed wide awake versus under sedation. Plast Reconstr Surg 2018;142(6):1532-8. https://doi.org/10.1097/PRS.0000000000004983
12. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
(disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J
Ind Med 1996;29(6):602-8. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
13. Saleh E, Saleh J, Govshievich A, Ferland-Caron G, Lin JC, Tremblay DM. Comparing minor hand procedures
performed with or without the use of a tourniquet: A randomized controlled trial. Plast Reconstr Surg Glob Open
2021;9(4):e3513. https://doi.org/10.1097/GOX.0000000000003513
14. Olaiya OR, Alagabi AM, Mbuagbaw L, McRae MH. Carpal tunnel release without a tourniquet: A systematic review and meta-Analysis. Plast Reconstr Surg 2020;145(3):737-44. https://doi.org/10.1097/PRS.0000000000006549
15. Gunasagaran J, Sean ES, Shivdas S, Amir S, Ahmad TS. Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet. J Orthop Surg (Hong Kong) 2017;25(3):2309499017739499. https://doi.org/10.1177/2309499017739
16. McKee DE, Lalonde DH, Thoma A, Dickson L. Achieving the optimal epinephrine effect in wide awake hand
surgery using local anesthesia without a tourniquet. Hand 2015;10(4):613-5. https://doi.org/10.1007/s11552-015-9759-6
17. Zhang JX, Gray J, Lalonde DH, Carr N. Digital necrosis after lidocaine and epinephrine injection in the flexor
tendón sheath without phentolamine rescue. J Hand Surg 2017;42(2):e119-e123. https://doi.org/10.1016/j.jhsa.2016.10.015
18. Zhu AF, Hood BR, Morris MS, Ozer K. Delayed-onset digital ischemia after local anesthetic with epinephrine
injection requiring phentolamine reversal. J Hand Surg 2017;42(6):479.e1-479.e4. https://doi.org/10.1016/j.jhsa.2017.01.006
2. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005;30(5):1061-7. https://doi.org/10.1016/j.jhsa.2005.05.006
3. Braithwaite BD, Robinson GJ, Burge PD. Haemostasis during carpal tunnel release under local anaesthesia: a
controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br 1993;18(12):184-6. https//doi.
org/10.1016/0266-7681(93)90103-m
4. Hutchinson DT, Mc Clinton MA. Upper extremity tourniquet tolerance. J Hand Surg 1993;18(2):206-10.
https://doi.org/10.1016/0363-5023(93)90347-6
5. Maury A, Roy W. A prospective, randomized, controlled trial of forearm versus upper arm tourniquet tolerance. J Hand Surg 2002;27(4):359-60. https://doi.org/10.1054/jhsb.2002.0787
6. Gibson M. Outpatient carpal tunnel decompression without tourniquet: a simple local anaesthetic technique. Ann R Coll Surg Engl 1990;72(6):408-9. PMID: 2241063
7. Koegst WH, Wölfle O, Thoele K, Sauerbier M. [The “wide awake approach” in hand surgery: a comfortable
anaesthesia method without a tourniquet]. Handchir Mikrochir Plast Chir 2011;43(3):175-80. https://doi.org/10.1055/s-0031-1280762 [En alemán]
8. Leinberry CF, Rivlin M, Maltenfort M, Beredjiklian P, Matzon JL, Ilyas AM, et al. Treatment of carpal tunnel
syndrome by members of the American Society for Surgery of the Hand: a 25-year perspective. J Hand Surg Am
2012;37(10):1997-2003.e3. https://doi.org/10.1016/j.jhsa.2012.07.016
9. Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery
in the main operating room versus the ambulatory setting in Canada. Hand (NY) 2007;2(4):173-8. https://doi.org/10.1007/s11552-007-9043-5
10. Rhee PC, Fischer MM, Rhee LS, McMillan H, Johnson AE. Cost Savings and Patient Experiences of a ClinicBased, Wide-Awake Hand Surgery Program at a Military Medical Center: A critical analysis of the first 100
procedures. J Hand Surg Am 2017;42(3):e139-e147. https://doi.org/10.1016/j.jhsa.2016.11.019
11. Alter TH, Warrender WJ, Liss FE, Ilyas AM. A cost analysis of carpal tunnel release surgery performed wide awake versus under sedation. Plast Reconstr Surg 2018;142(6):1532-8. https://doi.org/10.1097/PRS.0000000000004983
12. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
(disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J
Ind Med 1996;29(6):602-8. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
13. Saleh E, Saleh J, Govshievich A, Ferland-Caron G, Lin JC, Tremblay DM. Comparing minor hand procedures
performed with or without the use of a tourniquet: A randomized controlled trial. Plast Reconstr Surg Glob Open
2021;9(4):e3513. https://doi.org/10.1097/GOX.0000000000003513
14. Olaiya OR, Alagabi AM, Mbuagbaw L, McRae MH. Carpal tunnel release without a tourniquet: A systematic review and meta-Analysis. Plast Reconstr Surg 2020;145(3):737-44. https://doi.org/10.1097/PRS.0000000000006549
15. Gunasagaran J, Sean ES, Shivdas S, Amir S, Ahmad TS. Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet. J Orthop Surg (Hong Kong) 2017;25(3):2309499017739499. https://doi.org/10.1177/2309499017739
16. McKee DE, Lalonde DH, Thoma A, Dickson L. Achieving the optimal epinephrine effect in wide awake hand
surgery using local anesthesia without a tourniquet. Hand 2015;10(4):613-5. https://doi.org/10.1007/s11552-015-9759-6
17. Zhang JX, Gray J, Lalonde DH, Carr N. Digital necrosis after lidocaine and epinephrine injection in the flexor
tendón sheath without phentolamine rescue. J Hand Surg 2017;42(2):e119-e123. https://doi.org/10.1016/j.jhsa.2016.10.015
18. Zhu AF, Hood BR, Morris MS, Ozer K. Delayed-onset digital ischemia after local anesthetic with epinephrine
injection requiring phentolamine reversal. J Hand Surg 2017;42(6):479.e1-479.e4. https://doi.org/10.1016/j.jhsa.2017.01.006