Wide-awake vs. regional anesthesia for carpal tunnel release: a prospective study on pain, grip strength, and sleep...

Carpal tunnel release (CTR) is a common procedure for carpal tunnel syndrome (CTS), with WALANT (Wide-Awake Local Anesthesia No Tourniquet) and Axillary Brachial Plexus Block (ABPB) as two primary anesthesia options. This study compares their effects on pain, functional recovery, grip strength, and sleep quality.

A prospective observational study with quasi-randomization was conducted on 62 patients undergoing CTR under WALANT or ABPB. Outcomes included operative time, Visual Analog Scale (VAS) for pain, grip strength, and Pittsburgh Sleep Quality Index (PSQI). Patients were followed up at 1 week, 3 weeks, and 3 months postoperatively.

WALANT significantly reduced operative time compared to ABPB (mean: 20.8 ± 4.1 min vs. 41.5 ± 9.4 min; mean difference: 20.7 min; 95% CI: 16.3-25.1; p = 0.001; d = 2.45). It was also associated with significantly lower pain scores at both 3 weeks and 3 months. At 3 weeks, VAS scores were 0.7 ± 0.8 (WALANT) vs. 2.5 ± 2.1 (ABPB) (mean difference: 1.8; 95% CI: 0.6-2.9; p = 0.003; d = 1.00), and at 3 months, 0.3 ± 0.4 vs. 2.3 ± 1.4, respectively (mean difference: 2.0; 95% CI: 1.1-2.9; p = 0.003; d = 1.15). Early postoperative pain scores (1st hour and 1st day) were also lower in the WALANT group; however, these differences did not reach statistical significance. Grip strength recovery at 3 months showed no significant difference between groups in both thumb pinch and finger pinch measurements (p > 0.05). Similarly, sleep quality improvements assessed by PSQI did not significantly differ between groups at 3 months (WALANT: 5.7 ± 1.6 vs. ABPB: 5.9 ± 1.3; p = 0.868).

WALANT is a time-efficient and effective anesthesia method for CTR, offering prolonged pain relief without compromising functional recovery, grip strength, or sleep quality.