Wide awake local anesthesia no tourniquet (WALANT) versus axillary brachial plexus block for carpal tunnel release in a French public university hospital: Care pathways and operating room costs

Baptiste Boukebous; Cédric Maillot; Louis Charles Castel; Julia Donadio; Patrick Boyer; Marc Antoine Rousseau

doi:10.1016/j.otsr.2022.103358

Wide awake local anesthesia no tourniquet (WALANT) versus axillary brachial plexus block for carpal tunnel release in a French public university hospital: Care pathways and operating room costs

Orthop Traumatol Surg Res. 2023 May;109(3):103358. doi: 10.1016/j.otsr.2022.103358. Epub 2022 Jun 30.

Authors

Baptiste Boukebous¹, Cédric Maillot², Louis Charles Castel², Julia Donadio², Patrick Boyer², Marc Antoine Rousseau²

Affiliations

¹ Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat et Beaujon, université de Paris, Assistance publique des Hôpitaux de Paris, Paris, France. Electronic address: baptiste.boukebous@aphp.fr.
² Service de chirurgie orthopédique et traumatologique, hôpitaux Bichat et Beaujon, université de Paris, Assistance publique des Hôpitaux de Paris, Paris, France.

PMID: 35779792
DOI: 10.1016/j.otsr.2022.103358

Abstract

Introduction: The wide awake local anesthesia no tourniquet (WALANT) is a local anesthetic technique that theoretically cuts costs and shortens surgical waiting times, but this has yet to be demonstrated in France. The main objective of this study was to assess and compare the comprehensive care pathways and costs of performing carpal tunnel release (CTR) procedures in the ambulatory surgery unit using WALANT and axillary brachial plexus block (ABPB).

Methods: A total of 72 CTRs in 66 patients were reviewed after a minimum follow-up of 6 months. The anesthesia was performed by an anesthesiologist after a preoperative consultation. The surgical waiting time, operating room occupancy time, total time taken off work (TOW) and the return to work rate were recorded. The estimated total direct cost per patient (TDCPP) was the sum of the specialist consultation fees, the French diagnosis-related group (DRG) rates and the minimum daily cost of TOW (€27.30/day).

Results: Only the total operating room occupancy time differed significantly: 27minutes for the WALANT versus 37minutes for the ABPB (p=0.004). There were no complications or reoperations in either group. The total cost for the cohort was estimated at €190,970. The mean estimated TDCPP was €2,870 for the entire cohort, €2,543 for the ABPB and €2,713 for the WALANT (p=0.791). Twenty-seven of the 45 patients returned to work after a mean TOW of 3.1 months. Fourteen CTRs were preceded by a mean preoperative TOW of 27 days, which resulted in a cost of €24,948 (13% of the total cost). There were no significant differences in TOW or revision rate between WALANT and ABPB.

Conclusion: Although WALANT significantly reduced operating room occupancy times in our public hospital, the societal costs were the same regardless of the anesthesia technique. Reducing surgical waiting times in France could result in a theoretical saving of nearly €14 million annually.

Level of evidence: IV.

Keywords: Care pathway; Carpal tunnel release; Costs; Safety; WALANT.

MeSH terms

Anesthesia, Local / methods
Brachial Plexus Block*
Carpal Tunnel Syndrome* / surgery
Critical Pathways
Hospitals
Humans
Operating Rooms