Comparative Study, Walant vs Axillary Block in Carpal Tunnel Surgery

Zafer Soydan; İsmail Bülent Özçelik

doi:10.58600/eurjther1658

Authors

Zafer Soydan Department of Orthopedics and Traumatology, Nisantası University, Bhtclinic İstanbul Tema Hastanesi, Turkey https://orcid.org/0000-0001-6387-8628
İsmail Bülent Özçelik Department of Hand Surgery, İstanbul Yeni Yuzyil University Gaziosmanpaşa Hospital, Turkey https://orcid.org/0000-0002-0483-4956

DOI:

https://doi.org/10.58600/eurjther1658

Keywords:

Carpal Tunnel Surgery, WALANT, Axillary Block, VAS, patient satisfaction

Abstract

Objective: Wide awake local anesthesia no tourniquet (WALANT) is a local anesthetic technique that, in theory, reduces costs and surgical waiting periods. The purpose of this study was to compare axillary block (AXB) with WALANT in terms of pain scores, duration of hospital stay, and hand function in patients who underwent CTR surgery.

Methods: Between January 2015 and February 2020, a retrospective analysis was conducted on the outcomes of 410 patients who underwent CTS surgery. The Walant technique was utilized on 210 patients, while the AXB technique was utilized on 200 patients. These two groups were compared regarding operative time, hospital stay, VAS score at specific intervals before and after surgery, and hand function recovery.

Results: The mean operation time is 11 min (8-18) for the WALANT group and 12 min (5-34) for the AXB group. The average time of length of hospitalization is 4.2 hours (2-6) for WALANT and 14.2 hours (9-26) for AXB groups. The mean hospitalization time and the VAS scores of the WALANT group are significantly less than the AXB group (p=0.02 and p=0.03 respectively). The percentages of being able to use their hands compared to their nonoperative hands were evaluated. These rates were higher in the WALANT group than in the AXB group (65-75% vs. 45-60%).

Conclusion: Increased patient comfort was associated with the WALANT technique. It is superior to AXB in terms of patient satisfaction, postoperative long-term pain management, and hand function recovery. Assuming all safety recommendations are adhered to, WALANT is an alternative to tourniquets in CTS surgeries for obtaining a bloodless surgical field without the discomfort of tourniquet application.

Metrics

Metrics Loading ...

References

Keith MW, Masear V, Chung K, Maupin K, Andary M, Amadio PC, Barth RW, Watters WC 3rd, Goldberg MJ, Haralson RH 3rd, Turkelson CM, Wies JL. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009 Jun;17(6):389-96. https://doi.org/10.5435/00124635-200906000-00007

Elmaraghy MW, Hurst LN. Single-portal endoscopic carpal tunnel release: agee carpal tunnel release system. Ann Plast Surg 1996;36:286–91. https://doi.org/10.1097/00000637-199603000-00010

Apard T, Candelier G. Surgical ultrasound-guided carpal tunnel release. Hand Surg Rehabil. 2017 Oct;36(5):333-337. https://doi.org/10.1016/j.hansur.2017.05.005

Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol. 2017 Nov;42(9):886-895. https://doi.org/10.1177/1753193417728427

Boukebous B, Maillot C, Castel LC, Donadio J, Boyer P, Rousseau MA. 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. https://doi.org/10.1016/j.otsr.2022.103358

Mackinnon S, Novak C. (2017) Greenʼs Operative Hand Surgery, 7th Edn. In: Wolfe S, Hotchkis R, Pederson, W, Kozin S, Cohen M. 2017, Elsevier, Philadelphia, pp 930

Lied L, Borchgrevink GE, Finsen V. Wide Awake Hand Surgery. J Hand Surg Asian Pac Vol. 2017 Sep;22(3):292-296. https://doi.org/10.1142/S0218810417500320

Tang JB, Gong KT, Xing SG, Yi L, Xu JH. Wide-Awake Hand Surgery in Two Centers in China: Experience in Nantong and Tianjin with 12,000 patients. Hand Clin. 2019 Feb;35(1):7-12. https://doi.org/10.1016/j.hcl.2018.08.011

Mckee DE, Lalonde DH, Thoma A, Dickson L. Achieving the optimal epinephrine effect in wide awake hand surgery using local anesthesia without a tourniquet. Hand (N Y). 2015 Dec;10(4):613-5. https://doi.org/10.1007/s11552-015-9759-6

Alter TH, Warrender WJ, Liss FE, Ilyas AM. A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation. Plast Reconstr Surg. 2018 Dec;142(6):1532-1538. https://doi.org/10.1097/PRS.0000000000004983

Tang JB. Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer. Clin Orthop Surg. 2015 Sep;7(3):275-81. https://doi.org/10.4055/cios.2015.7.3.275

Leblanc MR, Lalonde DH, Thoma A, Bell M, Wells N, Allen M, Chang P, McKee D, Lalonde J. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y). 2011 Mar;6(1):60-3. https://doi.org/10.1007/s11552-010-9301-9

Kazmers NH, Presson AP, Xu Y, Howenstein A, Tyser AR. Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery. J Hand Surg Am. 2018 Nov;43(11):971-977.e1. https://doi.org/10.1016/j.jhsa.2018.03.051

Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose (1:1,000) epinephrine: Does it cause finger necrosis and should it be treated? Hand (N Y). 2007 Mar;2(1):5-11. https://doi.org/10.1007/s11552-006-9012-4

Yelnik AP, Hentzen C, Cuvillon P, Allart E, Bonan IV, Boyer FC, Coroian F, Genet F, Honore T, Jousse M, Fletcher D, Velly L, Laffont I; SOFMER group; SFAR group; Viel E. French clinical guidelines for peripheral motor nerve blocks in a PRM setting. Ann Phys Rehabil Med. 2019 Jul;62(4):252-264. https://doi.org/10.1016/j.rehab.2019.06.001

Menendez ME, Chen NC, Mudgal CS, Jupiter JB, Ring D. Physician Empathy as a Driver of Hand Surgery Patient Satisfaction. J Hand Surg Am. 2015 Sep;40(9):1860-5.e2. https://doi.org/10.1016/j.jhsa.2015.06.105

Hutchinson DT, McClinton MA. Upper extremity tourniquet tolerance. J Hand Surg Am. 1993 Mar;18(2):206-10. https://doi.org/10.1016/0363-5023(93)90347-6

Flatt AE. Tourniquet time in hand surgery. Arch Surg. 1972 Feb;104(2):190-2. https://doi.org/10.1001/archsurg.1972.04180020070013

Lalonde D, Eaton C, Amadio P, Jupiter J. Wide-awake Hand and Wrist Surgery: A New Horizon in Outpatient Surgery. Instr Course Lect. 2015;64:249-59.

Gunasagaran J, Sean ES, Shivdas S, Amir S, Ahmad TS. Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet. J Orthop Surg (Hong Kong). 2017 Sep-Dec;25(3):2309499017739499. https://doi.org/10.1177/2309499017739499