Abstract
There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the "wide awake local anesthesia no tourniquet" (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques. To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier's block), for surgical treatment of CTS. Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications. The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06). The WALANT technique is more effective than IVRA for CTS surgery.
Highlights
In most countries, surgical treatment of carpal tunnel syndrome (CTS) is usually performed in hospitals, using the open surgical technique that is preferred by specialists.[1,2,3] Anesthetic technique preferences vary among surgeons
We considered that failure of anesthesia had occurred when there was a need to change the anesthetic technique to which the patient had been allocated or when there was a need for surgical reintervention within the first three months after surgery
The patients had had their disease for a mean time of 4.5 years and most cases were considered to be moderate, as staged using electromyography
Summary
Surgical treatment of carpal tunnel syndrome (CTS) is usually performed in hospitals, using the open (classical) surgical technique that is preferred by specialists.[1,2,3] Anesthetic technique preferences vary among surgeons. Intravenous regional anesthesia (IVRA), as described by Bier, is in widespread use: it is the second most popular technique among American specialists and the most popular in Brazil.[4,5] over the last decade, performance of this surgery using the “wide awake local anesthesia no tourniquet” (WALANT) technique has been described This has proven to be a safe procedure with lower costs.[6,7,8]. Recent studies have compared surgical outcomes from CTS treatments, including the costs of WALANT versus general anesthesia; local anesthesia with adrenaline in association with sedation; and tourniquet application with monitored anesthetic care (MAC) and intravenous sedation. The conclusion from these studies was that local anesthesia was more effective and presented lower cost.[9,10,11] in evaluating the quality of evidence, we noticed that there was still a need for level I studies on this topic
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