WALANT Technique Versus Sedation for Endoscopic Carpal Tunnel Release

Overview

Journal Hand (N Y)

Publisher Sage Publications

Specialties General Surgery
Orthopedics

Date 2021 Apr 9

PMID 33834864

Citations 10

Authors

Ian Wellington

Antonio Cusano

Joel V Ferreira

Anthony Parrino

Affiliations

Soon will be listed here.

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, = .007) and WALANT groups (53.5 ± 15.8, = .008), (2, 153) = 6.465, = .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), (2, 153) = 5.732, = .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, (2, 153) = 101.1, < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, (2, 153) =171.1, < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, (2, 153) = 109.3, < .001). There were no differences in complication rates.

Conclusions: Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

Citing Articles

Network meta-analysis comparing WALANT, locoregional, local and general anesthesia techniques in carpal tunnel release.

Focsa L, Bouche P, Apard T, Querel D, Rousseau M, Descamps J EFORT Open Rev. 2025; 10(1):3-13.

PMID: 40071930 PMC: 11728873. DOI: 10.1530/EOR-2024-0014.

A Comparative Analysis of Endoscopic Carpal Tunnel Release Performed Under Wide-Awake, Local Anesthesia, No Tourniquet in an Office-based Procedure Room Versus Operating Room Setting.

Milhoan M, Scambler W, Pientka 2nd W J Hand Surg Glob Online. 2025; 7(1):33-36.

PMID: 39991602 PMC: 11846604. DOI: 10.1016/j.jhsg.2024.09.007.

State-of-the-art review: The advantage and use of Wide Awake Local Anaesthesia No Tourniquet (WALANT) for nerve decompression surgery.

Ahmad A, Lalonde D Int Orthop. 2025; .

PMID: 39951053 DOI: 10.1007/s00264-025-06432-4.

Wide Awake Local Anaesthesia No Tourniquet Surgery of the Foot and Ankle: A Review of Indications, Technique, Patient Satisfaction, and Complications.

Hamid M, Younis Z, Mannan M, Kalim Z, Khan Z, Prabhu R Cureus. 2025; 16(12):e74939.

PMID: 39744295 PMC: 11688574. DOI: 10.7759/cureus.74939.

Intraoperative Cost Comparison of Endoscopic Carpal Tunnel Release With WALANT Versus MAC Anesthesia.

Godfrey J, Benda J, Choi W, Tavakolian J, Owen E Hand (N Y). 2024; :15589447241284791.

PMID: 39469877 PMC: 11559941. DOI: 10.1177/15589447241284791.

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