Comparison of WALANT versus locoregional nerve block in staged bilateral endoscopic carpal tunnel release

Carpal tunnel release can be performed as open or endoscopic surgery. In WALANT (wide awake local anesthesia no tourniquet) a tourniquet is not used, ensuring less discomfort for the patient. In locoregional distal nerve block, on the other hand, a tourniquet is needed and can be painful. This raises the question as to which method of anesthesia is actually preferred for the patient and the surgeon. Patients undergoing staged bilateral carpal tunnel release present a unique opportunity to study this question.

Fifteen patients were included in this prospective study. The primary endpoint was the preference for anesthesia type in patients and surgeons. Surgeon preference was based on the visibility and fluency of the procedure. Secondary endpoints for patients comprised pain scores for performing surgery and anesthesia and pain caused by the tourniquet.

Baseline demographic and clinical information was collected. There was no significant difference in pain for performing local anesthesia or surgery. Surgeons may find that performing endoscopic release under WALANT is more challenging, as visibility tends to be significantly poorer. The mean pain caused by the tourniquet used during the wrist block procedure was rated as 3.6. In both surgeries, 77% (10/13) of the patients preferred the WALANT anesthesia.

In general, endoscopic carpal tunnel release was better tolerated under WALANT than locoregional distal nerve block. Although statistical analysis showed no significant difference in visibility and fluency for the surgeon between the two anesthesia techniques, we do not recommend endoscopic release under WALANT due to the consistent report of reduced visibility in the surgical field. This limitation, likely related to the presence of anesthetic fluid, may have failed to reach statistical significance due to small sample size, but is nevertheless a considerable challenge in practice.

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