Endoscopic Carpal Tunnel Release Using Wide-Awake Anesthesia

Abstract

Purpose: We report on patient and surgeon experience after single-port endoscopic carpal tunnel release (CTR) using wide-awake local anesthesia no tourniquet (WALANT) technique. Methods: From July to November 2018, patients undergoing endoscopic CTR with WALANT were prospectively included. Follow-up was 3 months. Patient ratings before, during, and after the operation were collected. We recorded the surgeon’s experience during surgery compared with the endoscopic CTR under local anesthesia with exsanguination and tourniquet. Complications were defined as nerve injury, infection, or the need for revision surgery. Results: The cohort consisted of 20 patients (24 wrists). All patients except one reported a complete or substantial decrease of symptoms. The 2 surgeons involved judged the procedure to be technically more demanding owing to impaired visualization (33%) caused by increased bleeding and edema in the operative field. There was one conversion from endoscopic to open surgery. Conclusions: We recommend starting single-port endoscopic CTR using WALANT with a noninflated tourniquet in place for use when necessary. Type of study/level of evidence: Therapeutic IV. Key words: Carpal tunnel syndrome, Endoscopic, Patient-reported outcome, Wide awake hand surgery