Related Experiment Video
Updated: May 21, 2025

Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Intraoperative Pain During Carpal Tunnel Release Performed by Experienced Surgeons: A Prospective Randomized Trial
Ignacio Rellán1, Nicolas Martin Molho1, Agustín Guillermo Donndorff1
1Department of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Purpose:
The purpose of this study was to compare the intraoperative pain in carpal tunnel decompression (CTD) using lidocaine + epinephrine (wide awake local anesthesia no tourniquet [WALANT]) versus local anesthesia (lidocaine) and tourniquet (LA-T).
Methods:
Patients with a diagnosis of carpal tunnel syndrome (CTS) and meeting the indications for surgical treatment were enrolled in a prospective, randomized, controlled study. Patients were randomized to two different local anesthetic techniques: WALANT and LA-T. All patients were operated on by a fellowship-trained hand surgeon not blinded to the intervention. After surgery, patients completed a questionnaire evaluating intraoperative pain using a visual analog scale. The minimal clinically important difference was assumed to be 2 points.
Results:
A total of 69 patients were enrolled, including 35 in the WALANT arm and 34 in the LA-T arm. All patients completed the questionnaire and complied with the prescribed follow-ups up to 28 days after surgery. Intraoperative pain was 1 point (interquartile range [IQR], 0-2) in the WALANT group and 2 points (IQR, 1-4) in the LA-T technique. Although this difference was statistically significant, it was not considered clinically relevant because it did not reach the minimal clinically important difference.
Conclusions:
Carpal tunnel decompression performed under WALANT presents similar intraoperative pain scores compared to the LA-T technique when performed by an experienced surgeon. Our findings may not apply to other procedures that could potentially have a longer duration.
Type Of Study/Level Of Evidence:
Therapeutic II.
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