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Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine.
Hand (N Y). 2019 Dec 07 [Online ahead of print]H

Abstract

Background:

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.

Methods:

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.

Results:

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.

Conclusion:

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. Level of evidence: IV.

Authors+Show Affiliations

Department of Orthopaedics, West Virginia University, Morgantown, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31813286

Citation

Sraj, Shafic. "Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine." Hand (New York, N.Y.), 2019, p. 1558944719890038.
Sraj S. Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine. Hand (N Y). 2019.
Sraj, S. (2019). Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine. Hand (New York, N.Y.), 1558944719890038. https://doi.org/10.1177/1558944719890038
Sraj S. Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine. Hand (N Y). 2019 Dec 7;1558944719890038. PubMed PMID: 31813286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carpal Tunnel Release With Wide Awake Local Anesthesia and No Tourniquet: With Versus Without Epinephrine. A1 - Sraj,Shafic, Y1 - 2019/12/07/ PY - 2019/12/10/entrez PY - 2019/12/10/pubmed PY - 2019/12/10/medline KW - WALANT KW - carpal tunnel release KW - carpal tunnel syndrome KW - epinephrine KW - wide awake local anesthesia with no tourniquet SP - 1558944719890038 EP - 1558944719890038 JF - Hand (New York, N.Y.) JO - Hand (N Y) N2 - Background: 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. Methods: 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. Results: 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. Conclusion: 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. Level of evidence: IV. SN - 1558-9455 UR - https://www.unboundmedicine.com/medline/citation/31813286/Carpal_Tunnel_Release_With_Wide_Awake_Local_Anesthesia_and_No_Tourniquet:_With_Versus_Without_Epinephrine_ L2 - https://journals.sagepub.com/doi/10.1177/1558944719890038?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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