Use of Tourniquet Under Sedation Anesthesia or the Walant Techniques in Bilateral Carpal Tunnel Surgery: A Comparative Analysis

Abstract

Aim: The objective of the study was to compare the outcomes and patient satisfaction of two different anesthesia techniques; wide-awake-local anesthesia-no tourniquet (WALANT) and sedation anesthesia with a tourniquet, in open carpal tunnel release surgery for bilateral cases. Material and Methods: The study included 57 patients (41 female, 16 male) who underwent carpal tunnel release surgery between January 2016 and September 2021. The files were retrospectively evaluated and included in the present study. Patient evaluations were conducted using QuickDASH and Michigan Hand Outcomes Questionnaire scores before surgery, on the 15th day after suture removal, and at six months postoperatively. Surgical duration and complications were also recorded. Statistical analyses were performed to compare the outcomes between the two groups. Results: Both QDash and MHQ scores were analyzed for anesthesia effects on hands. The study's reliability was ensured by an 85% statistical power, 95% confidence level, and p<0.05 significance. The results showed no significant differences in QuickDASH and Michigan Hand Outcomes Questionnaire scores between WALANT and sedation anesthesia Surgical duration was similar for sedation and WALANT groups. Patient preference was inconclusive, with comfort and symptom relief prioritized. Notably, neither group experienced complications like nerve injuries or infections. Conclusion: The study found that both WALANT and sedation anesthesia with a tourniquet were equally effective and provided similar levels of patient comfort and satisfaction in open carpal tunnel release surgery. The choice between these techniques can be based on individual preferences and considerations.

Keywords

• Carpal Tunnel Syndrome
• Sedation
• Tourniquet

Kaynakça

1. Bezuhly M, Sparkes GL, Higgins A, et al. Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wideawake approach. Plast Reconstr Surg. 2007;119:1507-12.
2. Tulipan JE, Kim N, Abboudi J, et al. Open carpal tunnel release outcomes: performed wide awake versus with sedation. J Hand Microsurg. 2017;9:74-9.
3. Demircay E, Civelek E, Cansever T, et al. Anatomic variations of the median nerve in the carpal tunnel: a brief review of the literature. Turk Neurosurg. 2011;21:388-96.
4. Uygur F, Sever C, Yüksel F. Comparing the results of limited incision technique and standard longitudinal incision technique for carpal tunnel decompression by numerical grading system. Turk Neurosurg. 2009;19:51-7.
5. Olaiya OR, Alagabi AM, Mbuagbaw L, McRae MH. Carpal tunnel release without a tourniquet: a systematic review and meta-analysis. Plast Reconstr Surg. 2020;145:737-44.
6. Padua L, Padua R, Nazzaro M, Tonali P. Incidence of bilateral symptoms in carpal tunnel syndrome. J Hand Surg Br. 1998;23:603-6.
7. Via GG, Esterle AR, Awan HM, et al. Comparison of local-only anesthesia versus sedation in patients undergoing staged bilateral carpal tunnel release: a randomized trial. Hand (N Y). 2020;15:785-92.
8. Bagatur AE, Zorer G. The carpal tunnel syndrome is a bilateral disorder. J Bone Joint Surg Br. 2001;83:655-8.

9. Marks M. Which patient-reported outcomes shall we use in hand surgery?. J Hand Surg Eur Vol. 2020;45:5-11.
10. Oksüz C, Akel BS, Leblebicioğlu G, Kayıhan H. Which hand outcome measurement is best for Turkish speaking patients?. Acta Orthop Traumatol Turc. 2012;46:83-8.
11. Saleh E, Saleh J, Govshievich A, et al. Comparing minor hand procedures performed with or without the use of a tourniquet: a randomized controlled trial. Plast Reconstr Surg Glob Open. 2021;9:e3513.
12. Gallucci GL, Rosa YC, Cerrutti WG, et al. WALANT technique versus local anesthesia with a tourniquet in carpal tunnel syndrome. Arch Bone Jt Surg. 2023;11:321-5.
13. Moscato L, Helmi A, Kouyoumdjian P, et al. The impact of WALANT anesthesia and office-based settings on patient satisfaction after carpal tunnel release: a patient reported outcome study. Orthop Traumatol Surg Res. 2023;109:103134.
14. Wellington I, Cusano A, Ferreira JV, Parrino A. WALANT technique versus sedation for endoscopic carpal tunnel release. Hand (N Y). 2023;18:214-21.
15. Sasor SE, Cook JA, Duquette SP, et al. Tourniquet use in wide-awake carpal tunnel release. Hand (N Y). 2020;15:59-63.
16. Carroll TJ, Dussik CM, Clary Z, et al. Endoscopic versus open carpal tunnel surgery: risk factors and rates of revision surgery. J Hand Surg Am. 2023;48:757-63.
17. Börekci A, Selahi Ö, Tanriverdi N, et al. Accessory hand muscles over the transverse carpal ligament: an obstacle in carpal tunnel surgery. World Neurosurg. 2023;170:402-15.