Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine.

Abstract

<b>Background:</b> Wide awake local anesthesia and no tourniquet (WALANT) relies on epinephrine to create a relatively bloodless field. This study evaluated the effect of epinephrine on carpal tunnel release (CTR) surgical time and bleeding, including the need for use of a tourniquet or electrocautery. The hypothesis was that wide awake anesthesia without epinephrine is a viable option for CTR but increases operative time. <b>Methods:</b> Records of all patients who underwent CTR under wide awake anesthesia between October 2017 and September 2018 were reviewed. The injection consisted of either 10 cc of 1% lidocaine with 1:100,000 epinephrine mixed with 1 cc of sodium bicarbonate (8.4%) (WALANT group) or 10 cc of 1% lidocaine (wide awake local anesthesia, no tourniquet and no epinephrine [WALANE] group). The time between skin incision and skin closure was calculated. Tourniquet and electrocautery use as well as operative complications were documented. <b>Results:</b> Thirty-two patients underwent 43 CTRs; 22 CTRs were done under WALANT, and 21 CTRs were done under WALANE. The skin-skin time was 12.8 minute (6-25 minute; standard deviation [SD] = 4.7) for WALANT and 17.4 minute (9-30 minute; SD = 5.8) for WALANE. There was a significant statistical difference (36%) in skin-skin time between the 2 groups. None of the patients required electrocautery or a tourniquet. There were no operative complications. <b>Conclusion:</b> Operative time increased by 36% when epinephrine was not used. Epinephrine is not an absolute necessity to perform wide awake anesthesia but, at the same time, has the added value of decreasing surgical time. <b>Level of evidence:</b> IV.