WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release.

Abstract

This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, <i>P</i> = .007) and WALANT groups (53.5 ± 15.8, <i>P</i> = .008), <i>F</i>(2, 153) = 6.465, <i>P</i> = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), <i>F</i>(2, 153) = 5.732, <i>P</i> = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, <i>F</i>(2, 153) = 101.1, <i>P</i> < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, <i>F</i>(2, 153) =171.1, <i>P</i> < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, <i>F</i>(2, 153) = 109.3, <i>P</i> < .001). There were no differences in complication rates. Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.