Endoscopic Carpal Tunnel Release Using Wide-Awake Anesthesia

Abstract

We report on patient and surgeon experience after single-port endoscopic carpal tunnel release (CTR) using wide-awake local anesthesia no tourniquet (WALANT) technique. Methods: From July to November 2018, patients undergoing endoscopic CTR with WALANT were prospectively included. Follow-up was 3 months. Patient ratings before, during, and after the operation were collected. We recorded the surgeon's experience during surgery compared with the endoscopic CTR under local anesthesia with exsanguination and tourniquet. Complications were defined as nerve injury, infection, or the need for revision surgery. Results: The cohort consisted of 20 patients (24 wrists). All patients except one reported a complete or substantial decrease of symptoms. The 2 surgeons involved judged the procedure to be technically more demanding owing to impaired visualization (33%) caused by increased bleeding and edema in the operative field. There was one conversion from endoscopic to open surgery. Conclusions: We recommend starting single-port endoscopic CTR using WALANT with a noninflated tourniquet in place for use when necessary. Type of study/level of evidence: Therapeutic IV.

“Anesthesia for Endoscopic Carpal Tunnel Syndrome Release: A Comprehensive Systematic Review and Meta-Analysis of Local Versus Regional Versus General Anesthesia”

“…We included data from 12 studies in the present systematic review ( Figure 1 ), and 11 studies were included in the meta-analysis. 10 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 These studies were published between 2001 and 2021. Six studies were published in European countries, 22 , 24 , 25 , 26 , 27 , 29 while the remaining studies were published in the United States.…”

“… 10 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 These studies were published between 2001 and 2021. Six studies were published in European countries, 22 , 24 , 25 , 26 , 27 , 29 while the remaining studies were published in the United States. Two randomized clinical trials were included, 25 , 29 three studies were retrospective investigations, 23 , 27 , 28 and the rest were prospective cohort studies.…”

“…2001 23 USA R 273/0 273 N/A 68/205 LA ECTR (undefined) N/A tourniquet was inflated for 12.6 ± 5.4 min II Ly et al. 2019 24 Switzerland P 24/0 24 39-92 4/16 LA (WALANT) Single-port 14(7-25) II Nabhan et al. 2011 29 Germany RCT 43/0 43 41-69 18/26 LA versus RA ECTR L.A Group 28 ± 3.5 min IVRA Group 45 ± 3.9 min II Sørensen et al.…”

“…In all included studies, women were the majority (n = 9914/1450, 68.35%); in two articles, gender was not mentioned. 20 , 28 In seven articles, LA was administered, 12 , 20 , 22 , 23 , 24 , 27 , 28 two articles compared LA with regional anesthesia, 25 , 29 one article used only regional anesthesia (median and ulnar nerve block), 26 one article used LA with sedation versus WALANT only, 21 and one article compared general anesthesia or regional anesthesia versus LA. 29 Regarding the clinical and operative characteristics, the duration of presenting complaints of CTS was presented in two studies, 22 , 24 with a mean duration of 43.3 months.…”

Procedural Technique for Wide Awake Local Anesthesia No Tourniquet Injection for Endoscopic Carpal Tunnel Release

“…The lack of adequate visualization during WALANT ECTR is a common reason for conversion to an open procedure. Ly et al 8 described their experience with WALANT ECTR. Of the 24 cases performed, 8 cases had impaired visualization of the TCL secondary to bleeding and edema.…”