Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation

Abstract

Carpal tunnel release (CTR) is the most common surgery of the hand, and interest is growing in performing it under local anesthesia without tourniquet. To better understand differences, we hypothesized that patients undergoing CTR under wide-awake local anesthesia with no tourniquet (WALANT) versus sedation (monitored anesthesia care [MAC]) would not result in a difference in outcome. Consecutive cases of electrodiagnostically confirmed open CTR across multiple surgeons at a single center were prospectively enrolled. Data included demographic data, visual analog scale, Levine-Katz carpal tunnel syndrome scale, QuickDASH questionnaire, customized Likert questionnaire, and complications. There were 81 patients enrolled in the WALANT group and 149 patients in the MAC group. There were no reoperations in either group or any epinephrine-related complications in the WALANT group. Disability and symptom scores did not differ significantly between WALANT and sedation groups at 2 weeks or 3 months. Average postoperative QuickDASH, Levine-Katz, and VAS pain scales were the same in both groups. Both groups of patients reported high levels of satisfaction at 91 versus 96% for the WALANT versus MAC groups, respectively ( > 0.05). Patients in each group were likely to request similar anesthesia if they were to undergo surgery again. Patients undergoing open CTR experienced similar levels of satisfaction and outcomes with either the WALANT or MAC techniques. There was no statistically significant difference between either group relative to the tested outcome measures. These data should facilitate surgeons and patients' choosing freely between WALANT and MAC techniques relative to complications and outcomes.

<p>Open cubital and carpal tunnel release using wide-awake technique: reduction of postoperative pain</p>

“…Postoperative VAS scores in group WA were significantly lower during the immediate postoperative period. Tulipan et al reported that there was no difference in VAS scores at 2 weeks and 3 months after surgery when WA and sedation were compared as an anesthetic method of CTS 13. However, this study did not address immediate postoperative pain.…”

Wide-awake local anesthesia for clavicle fracture fixation: A case report

“…Moreover, the WALANT technique can be used in patients who are at a risk of adverse effects from general anesthesia. This technique has been used in various operations in orthopedic surgery, such as distal radius fracture, ulnar shaft fracture, and olecranon fracture [ [2] , [3] , [4] , [5] ]. However, its use has not yet been reported in a mid-shaft clavicular fracture.…”

“…Wide-awake local anesthesia no tourniquet (WALANT) has been widely used in orthopedic surgery [ [2] , [3] , [4] , [5] ]. However, there have been no reports of its use in clavicular surgery.…”

Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

“…Carpal tunnel release is performed as an outpatient procedure and thus, the demand of earlier discharge and increased efficiency has led to consideration of alternative anesthesia techniques than sedation (monitored anesthesia care [MAC]). 1 Wide awake carpal tunnel surgery provides significant cost saving with almost the same patients’ satisfaction as sedation anesthesia. 8 9 10 Several regional anesthesia techniques, such as brachial plexus blocks, 11 12 intravenous regional anesthesia, 13 wrist blocks, 14 15 and local infiltration 14 15 16 17 have been introduced.…”

“…It may be performed under wide awake local anesthesia and is well tolerated by the patients. 1 Besides, superficial infiltration of the local anesthetic provides adequate intraoperative analgesia. 2 The advantage of using local anesthesia in such surgical procedures is that it allows a rapid turnover of patients and avoids the complications of regional and general anesthesia.…”