Postoperative pain after carpal tunnel or trigger digit release using local anaesthesia with tourniquet or WALANT

Local anaesthesia with tourniquet (LA-T) and wide-awake local anaesthesia no tourniquet (WALANT) are both commonly used in hand surgery. However, the differences in postoperative pain between these methods in various procedures are unclear.

We conducted a retrospective single-surgeon case series of 356 procedures (184 LA-T; 172 WALANT) between 2015 and 2019. Included cases were unilateral carpal tunnel release and single-digit A1 pulley release. Postoperative pain was assessed on days 1-3 and at 2 weeks using patient-reported pain scores, sleep disturbance, hospital visits and need for additional or prolonged analgesics. Operative time and pain-free interval were also recorded.

In carpal tunnel release, WALANT was associated with longer pain-free intervals, lower peak pain, less pain at first follow-up, fewer reports of sleep disturbance and less use of additional and prolonged analgesics. Operative time was shorter with LA-T. In A1 pulley release, although LA-T had a shorter operative time and pain-free interval, most pain-related outcomes were similar between the groups.

WALANT provided superior early pain control in carpal tunnel release. For A1 pulley release, LA-T remains a useful option. Anaesthesia selection should be tailored to the procedure and individual patient factors.Level of evidence: III.