Treatment of Cubital Tunnel Syndrome Under WALANT Technique Through a Mini-Open Approach: Surgical Technique and Case Series with Short-Term Follow-up.

Abstract

Wide-Awake Local Anesthesia No Tourniquet (WALANT) has expanded its applications over the past decade from common hand procedures to a broader range of more complex surgeries. However, despite its frequent use, there is limited literature on WALANT for cubital tunnel syndrome. We have adapted the endoscopic technique reported by other colleagues to a mini-open approach. This approach is characterized by a smaller incision while preserving its blood supply. Our objective is to describe this two-stage local anesthetic injection method that has enabled us to safely and successfully treat 16 patients without complications. We conducted a retrospective cohort study. Sixteen patients meeting specific inclusion criteria underwent ulnar nerve decompression under WALANT. Patients were preoperatively classified according to Dellon's classification. Surgical technique included a staged local anesthetic solution infiltration and careful dissection to preserve nerve stability. Preoperative classification revealed six mild, six moderate, and four severe cases. Intraoperative discomfort was reported by four patients before incorporating a second stage of distal local anesthetic infiltration. All patients exhibited stable intraoperative ulnar nerve positioning and were discharged independently 20 min post-surgery. Follow-up at an average of 12 weeks (range 10 -18 weeks) showed symptom resolution in all patients. No complications, including iatrogenic injury to medial antebrachial cutaneous nerve branches, were reported. This study demonstrates the feasibility and effectiveness of the WALANT technique for ulnar nerve decompression at the elbow. Incorporating a staged local anesthetic infiltration enhances patient comfort. The online version contains supplementary material available at 10.1007/s43465-025-01362-0.