WALANT Technique versus Local Anesthesia with a Tourniquet in Carpal Tunnel Syndrome

Document Type : RESEARCH PAPER


1 1 Instituto de Ortopedia y Traumatología “Carlos E. Ottolenghi”. Servicio de Ortopedia y Traumatología Hospital Italiano de Buenos Aires, Argentina 2 Centro de Ortopedia y Traumatología Quilmes, Buenos Aires, Argentina

2 Centro de Ortopedia y Traumatología Quilmes, Buenos Aires, Argentina

3 Instituto de Ortopedia y Traumatología “Carlos E. Ottolenghi”. Servicio de Ortopedia y Traumatología Hospital Italiano de Buenos Aires, Argentina


Objectives: Obtaining a blood-free surgical field is critical during carpal tunnel decompression (CTD) to 
identify anatomic structures and avoid iatrogenic injury. A tourniquet is often used to minimize bleeding 
and improve visualization. However, it may be associated with discomfort and intolerance when 
sedation is not employed. WALANT ("Wide awake local anesthesia no tourniquet") technique surgeries 
have become very popular and enable the patient to be involved in the procedure; in addition, the 
adrenaline avoids the use of the tourniquet and the discomfort it produces. We hypothesized that there 
is no difference in postoperative pain after CTD between local anesthetic with a tourniquet (LA-T) and 
WALANT technique. The objective of this paper is to report the results of CTD, comparing those 
performed with local anesthesia and those performed with the WALANT.
Methods: In this prospective study, 60 CTS were operated in two different institutions. Patients in group 1 (30 
patients) were operated under LA-T, while patients in group 2 (30patients) were operated on using lidocaine with 
epinephrine (WALANT). Statistical analysis was performed.
Results: Postoperative pain immediately after surgery, at 4 and 24 hours, and 15, and 30 days after surgery; and 
degree of satisfaction did not show a significant difference between the two groups. Moreover, surgical time was 
slightly shorter in the LA-T group, but the difference was not significant.
Conclusion: In our study, CTD performed with LA-T, and WALANT technique resulted in similar results. In cases 
of experienced surgeons, LA-T may be enough to perform the procedure, avoiding epinephrine's low but complex 
complications. In less experienced surgeons who require more surgical time, the use of WALANT may increase the 
intraoperative comfort of the patient. 
 Level of evidence: IV


Main Subjects

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Volume 11, Issue 5
May 2023
Pages 321-325
  • Receive Date: 22 January 2022
  • Revise Date: 04 October 2022
  • Accept Date: 12 January 2023
  • First Publish Date: 04 April 2023