WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Abstract

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

“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.…”

“…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. For the following reasons, four articles were excluded: reported no outcome of interest (n = 3) and insufficient data were available (n = 1).…”

“…2005 27 Turkey R 10/0 10 35-58 2/8 LA Two-portal Chow technique N/A II Wellington et al. 2021 28 USA R 156/0 156 MT: (36.4-55.8) LT: (42.2-70.4) WALANT: (37.7-69.3) NA LA (WALANT) ECTR WALANT: 10 min MT: 11 min LT 11 min II Foster et al, 2017 30 Turkey R 2238/ 7273 2238 30-70 4409/9497 GA, LA, RA E: endoscopic surgeries; O: open surgeries; M: male; F: female; ECTR: endoscopic carpal tunnel; P: prospective; R: retrospective; RCT: randomized clinical trials; LA: Local anesthesia; GA: General anesthesia; RA: Regional anesthesia; WALANT: wide awake local anesthesia no torniquet. …”

“…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.…”

“… Wellington et al. 2021 28 Superficial infections:3 (2 LT, 1 WALANT), Aseptic Flexor Tenosynovitis: 2 (2 MT) NA NA NA NA Foster et al, 2017 30 NA NA NA NA NA IVRA: intravenous regional anesthesia; LA: local anesthesia; WALANT: wide-awake, local anesthesia, no tourniquet; LT: local anesthesia with tourniquet; MT: monitored anesthesia care with tourniquet

Figure 2 A forest plot shows the prevalence of post-surgery complications in included studies.

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