"Patients' Perspective for Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia".Plast Reconstr Surg. 2020 Feb 05 [Online ahead of print]PR
We conducted a prospective study to compare patients' intraoperative experience of open carpal tunnel release (CTR) under "wide awake local anesthesia no tourniquet" (WALANT) on one hand and intravenous regional anesthesia (IVRA) on the contralateral hand. We hypothesized that WALANT would offer better intraoperative experience than IVRA.
There were 24 bilateral CTS patients who had one hand operated on using WALANT and the contralateral hand with the IVRA method. At the postoperative second hour, patients were asked to complete a questionnaire to quantify their pain levels on a numerical rating scale (NRS) and compare the operation to dental procedures. They were also asked about their expectations and their feelings about re-operation with the anesthesia methods. The results were compared for the two anesthesia methods.
There were no significant differences between NRS pain values during anesthetic administration and between NRS pain values for surgical site pain on the WALANT and IVRA sides. Patients reported moderate tourniquet pain for IVRA sides. For WALANT sides, a significantly higher number of patients reported CTR to be an easier procedure than dental procedures (91.6% WALANT and 37.5% IVRA). When compared with patients' expectations, patients reported CTR with WALANT and IVRA [91.6% and 50%, respectively] to be an easier procedure than they expected. For the re-operation anesthesia method; 83.3% of patients preferred WALANT, 8.3% preferred IVRA, and 8.3% reported no preference.
WALANT offered a better intraoperative experience. Tourniquet pain, preoperative preparation basics, and the extended anesthesia duration are likely the major drawbacks of the IVRA method.