Case Series: Wide-Awake Local Anaesthesia Without Tourniquet (WALANT) for Camitz Transfer

Area of Science:

• Orthopaedic Surgery
• Hand Surgery
• Anaesthesiology

Background:

• Wide-Awake Local Anaesthesia Without Tourniquet (WALANT) is recognized for its simplicity and low complication rates in orthopaedic surgery.
• The application of WALANT for the Camitz transfer procedure has not been previously reported.
• Severe carpal tunnel syndrome with thenar muscle atrophy necessitates surgical intervention, such as the Camitz transfer.

Purpose of the Study:

• To evaluate the early outcomes of utilizing the WALANT technique for the Camitz transfer procedure.
• To compare the outcomes of WALANT-assisted Camitz transfer with existing literature data.
• To establish the safety and efficacy of WALANT in this specific surgical context.

Main Methods:

• A prospective study included 36 patients undergoing Camitz transfer for severe carpal tunnel syndrome under WALANT at Thammasat University Hospital (January 2012 - January 2018).
• The WALANT technique involved specific volumes of local anaesthetic injected around the palmaris longus tendon and the thumb's metacarpophalangeal joint.
• Data collected included patient demographics, Visual Analogue Scale (VAS) pain scores during injection and procedure, operative time, blood loss, and complications.

Main Results:

• Thirty-six patients (8 male, 28 female, average age 65.9 years) were analyzed.
• Average VAS pain scores were 6.22 during injection and 0.52 during the procedure.
• The average operative time was 27.06 minutes, with a mean blood loss of 3 mL. No complications were reported in any patient.

Conclusions:

• The WALANT technique is a safe anaesthesia option for the Camitz transfer procedure.
• WALANT can be considered a suitable alternative anaesthesia for Camitz transfer, demonstrating favorable early outcomes.
• This study supports the use of WALANT for Camitz transfer in patients with severe carpal tunnel syndrome and thenar atrophy.