178 Walant technique improves the efficiency of distal nerve blocks for carpal tunnel release

Background and Aims Axillary block is the standard for carpal tunnel release (CTR), providing good anesthesia and tolerance of tourniquet. Distal blocks, efficient and preventing motor block, are less used due to a poor tolerance of tourniquet (1). This study was designed to assess the benefits of the addition of a tumescent local anesthesia (WALANT: Wide Awake Local Anesthesia No Tourniquet) to distal blocks during CTR. Methods After approval of the Ethics Committee and written informed consent, 30 patients scheduled for CTR were enrolled in this prospective, randomized, open-label study. Distal blocks (median – ulnar – lateral cutaneous nerve of forearm) were performed under ultrasound with Ropivacaine 0.375% (5–7 ml) (TOURNIQUET and WALANT groups). In WALANT, an additional infiltration of 7 ml lidocaine and epinephrine was performed in the area of surgery (= local hemostasis). In TOURNIQUET, a high arm tourniquet was used. Pain score, patient satisfaction, quality of endoscopic surgical procedure (visualization), need of rescue tourniquet in WALANT, efficiency, rate of complications were noted. Results Demographic data are presented in table 1. WALANT significantly reduced pain score and the use of sedation. Even if the quality of visualization was high in both groups, it was better in TOURNIQUET (table 2). No rescue tourniquet was necessary in WALANT. The rate of hematoma 15 days post-surgery was higher in TOURNIQUET. No other adverse event was observed. Conclusions Addition of WALANT to distal blocks is adapted for CTR. WALANT improves the comfort of the patient and the quality of anesthesia and provides good surgery conditions.