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Wide Awake vs Sedation in Carpal Tunnel Surgery: A Mixed-Methods Study on Patient Decision Making and Pain
Bryce F Rizvanović1, Samuel Nofsinger, Nash Kolb
1. Department of Orthopaedic Surgery, University of Missouri - Columbia, Columbia, Missouri.
Plastic and Reconstructive Surgery
|June 15, 2026
Summary
Patients undergoing carpal tunnel release (CTR) choose anesthesia based on a desire for control and awareness (Wide-awake local anesthesia no tourniquet - WALANT) or a preference for relinquishing control (sedation), not pain levels.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Psychology
Background:
- Carpal tunnel release (CTR) commonly uses Wide-awake local anesthesia no tourniquet (WALANT) or sedation, with similar outcomes.
- Patient psychological and experiential factors influencing anesthesia choice for CTR are not well understood.
Purpose of the Study:
- To investigate the cognitive, emotional, and experiential drivers of anesthesia selection for CTR.
- To compare patient decision-making processes for WALANT versus sedation.
Main Methods:
- Mixed-methods study of 30 patients undergoing primary CTR (15 WALANT, 15 sedation).
- Preoperative validated questionnaires assessed pain, catastrophizing, sensitivity, self-efficacy, and PROMIS-29.
- Semi-structured interviews explored expectations and decision-making; qualitative data analyzed using constant comparative methodology.
Main Results:
- No significant demographic, PROMIS-29, or pain-related differences between WALANT and sedation groups.
- WALANT patients prioritized autonomy, control, and awareness.
- Sedation patients preferred avoidance and relinquishing control, linked to locus of control.
Conclusions:
- Anesthesia choice for CTR is influenced by patient preferences for control and agency, not solely pain or anxiety.
- Locus of control is a key differentiator in anesthesia decision-making for CTR.
- Preoperative counseling should address locus of control to align anesthesia choice with patient values.
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