Wide Awake Local Anesthesia No Tourniquet (WALANT) technique improves the efficiency of distal nerve blocks for carpal tunnel release

Sébastien Bloc; Pierre Squara; Cyril Quemeneur; Mélanie Doirado; Laurent Thomsen; Messaouda Merzoug; Cécile Naudin; Fréderic Le Saché

doi:10.1016/j.accpm.2023.101229

Wide Awake Local Anesthesia No Tourniquet (WALANT) technique improves the efficiency of distal nerve blocks for carpal tunnel release

Anaesth Crit Care Pain Med. 2023 Aug;42(4):101229. doi: 10.1016/j.accpm.2023.101229. Epub 2023 Apr 7.

Authors

Sébastien Bloc¹, Pierre Squara², Cyril Quemeneur³, Mélanie Doirado⁴, Laurent Thomsen⁵, Messaouda Merzoug², Cécile Naudin², Fréderic Le Saché⁶

Affiliations

¹ Department of Anesthesiology, Clinique Drouot Sport, Paris, France; Department of Clinical Research, CMC Ambroise Paré, Neuilly-sur-Seine, France. Electronic address: agsb@mac.com.
² Department of Clinical Research, CMC Ambroise Paré, Neuilly-sur-Seine, France.
³ Department of Anesthesiology, Clinique Drouot Sport, Paris, France; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
⁴ Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
⁵ Department of Orthopedic Surgery, Clinique Drouot Sport, Paris, France.
⁶ Department of Anesthesiology, Clinique Drouot Sport, Paris, France; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France; Department of Anesthesiology, Clinique Jouvenet, Paris, France.

PMID: 37031817
DOI: 10.1016/j.accpm.2023.101229

Abstract

Background: Axillary block is the standard for carpal tunnel release (CTR), providing effective anesthesia, and tolerance of tourniquet. Conversely, distal blocks are less used due to poor tolerance of tourniquet. Wide Awake Local Anesthesia No Tourniquet (WALANT), proposed for hand and wrist surgeries, avoids its use. This study assesses the benefits of the addition of WALANT to distal blocks during endoscopic CTR (eCTR).

Methods: This randomized, open-label, controlled trial prospectively enrolled 60 patients scheduled for eCTR. Patients were randomized to receive distal blocks at the wrist combined to either a high arm tourniquet (Distal block group) or a WALANT in the area of surgery (Distal + Walant group). The primary endpoint was the global pain score summing pain scores related to puncture, local anesthetic injection, pneumatic tourniquet, surgical procedure, tourniquet deflation, and residual sensitivity after surgery.

Results: Mean global pain score was significantly reduced in the Distal + Walant group (0.5 ± 1.4 vs. 2.2 ± 2.4; p < 0.001). No need for an additional anesthetic procedure was required in the Distal + Walant group. Even if the quality of visualization was high in both groups, it was better in the Distal block group (5 [5-5] vs. 4 [4-5]; p < 0.001). No rescue tourniquet was necessary for the Distal + Walant group. The rate of hematoma 15 days post-surgery was significantly reduced in the Distal + Walant group (20% vs. 57%; p < 0.01).

Conclusions: The addition of WALANT to distal blocks is adapted for eCTR. This combined technique decreases perioperative pain scores, provides good surgery conditions, and reduces the risk of postoperative hematoma.

Clinical trial number and registry url: The trial was registered on ClinicalTrials.gov (NCT04494100) on July 31, 2020 https://clinicaltrials.gov/ct2/show/NCT04494100?term=CMC+ambroise+pare&cntry=FR&draw=4&rank=28.

Keywords: Carpal tunnel release; Distal nerve block; Pneumatic tourniquet; Regional anesthesia; Wide Awake Local Anesthesia No Tourniquet.

Publication types

Randomized Controlled Trial

MeSH terms

Anesthesia, Local / methods
Anesthetics, Local
Carpal Tunnel Syndrome* / surgery
Humans
Nerve Block*
Pain

Substances

Anesthetics, Local

Associated data

ClinicalTrials.gov/NCT04494100