Endoscopic Carpal Tunnel Release Using Wide-Awake Anesthesia.

Area of Science:

• Orthopedic Surgery
• Minimally Invasive Procedures

Background:

• Carpal tunnel syndrome (CTS) is a common condition requiring surgical intervention.
• Traditional endoscopic carpal tunnel release (CTR) often involves local anesthesia with exsanguination and tourniquet.
• The wide-awake local anesthesia no tourniquet (WALANT) technique offers a potential alternative for outpatient procedures.

Purpose of the Study:

• To evaluate patient and surgeon experience with single-port endoscopic CTR using the WALANT technique.
• To compare surgeon experience with WALANT versus traditional local anesthesia for endoscopic CTR.
• To assess patient outcomes and complication rates associated with single-port endoscopic CTR using WALANT.

Main Methods:

• Prospective cohort study including 20 patients (24 wrists) undergoing single-port endoscopic CTR with WALANT.
• Patient-reported outcomes collected pre-, intra-, and post-operatively.
• Surgeon experience documented, focusing on technical aspects and visualization.
• Complications defined as nerve injury, infection, or need for revision surgery.

Main Results:

• High patient satisfaction with 95% reporting significant symptom reduction.
• Surgeons reported increased technical difficulty in 33% of cases due to impaired visualization from bleeding and edema.
• One conversion to open surgery was required.

Conclusions:

• Single-port endoscopic CTR with WALANT is a viable option for symptom relief in carpal tunnel syndrome.
• Modified technique, such as using a noninflated tourniquet, may mitigate visualization challenges.
• Further research can optimize the WALANT technique for single-port endoscopic CTR.