Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Background: Carpal tunnel release (CTR) is one of the most common upper extremity procedures, reaching 400,000 - 600,000 procedures yearly in the United States. With such a common procedure, it is pertinent that every step is as comfortable for the patient as possible. Many patients report discomfort due to the usage of a tourniquet during the anesthesia process. However, a growing number of physicians are beginning to use the wide awake local anesthesia no tourniquet (WALANT) approach. WALANT utilizes a distal nerve block (commonly Ropivacaine), Lidocaine, Epinephrine, but no tourniquet. The more commonly used approach utilizes the same distal nerve block, in combination with a tourniquet. To date, there have been no systematic reviews or meta-analyses evaluating whether the WALANT approach yields lower pain than a distal nerve block with a tourniquet during CTR.
Purpose: We conducted a systematic review and pooled analysis comparing the WALANT technique to using a tourniquet with a distal nerve block on the pain experienced by patients during carpal tunnel release.
Methods: This systematic review and pooled analysis followed the 2020 PRISMA guidelines. Five online databases (Cochrane, Embase, Scopus, Web of Science, Pubmed) were screened for studies that included intraoperative Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) scores of patients having CTR with either the WALANT approach or a tourniquet with a distal nerve block. After the screening process, 2 randomized controlled trials (RCTs) were included in the final analysis, yielding a total of 90 distinct patient evaluations.
Results: The results portray a strong clinical significance (Cohen’s d = 1.03, 95% CI 0.59-1.47) on pain reduction, in favor of utilizing the WALANT technique.
Conclusion: Our systematic review and pooled analysis serves as a preliminary study in the exploration of the WALANT technique, specifically for CTR. The results illustrate that WALANT is a promising method in reducing patient pain during this procedure, portrayed by the large effect size between using a tourniquet with a distal block, and WALANT. Future RCTs are needed to control for the drug and dose of nerve block used, and to increase the sample size.
Keywords
Carpal Tunnel Release, Carpal Tunnel Syndrome, Orthopedic Surgery, Anesthesiology, WALANT, Pain, Nerve Block
Document Type
Poster
Wide Awake Local Anesthesia No Tourniquet (WALANT) Is More Effective at Decreasing Pain Compared to Distal Nerve Block With a Tourniquet During Carpal Tunnel Release Surgery: A Systematic Review and Pooled Analysis
Background: Carpal tunnel release (CTR) is one of the most common upper extremity procedures, reaching 400,000 - 600,000 procedures yearly in the United States. With such a common procedure, it is pertinent that every step is as comfortable for the patient as possible. Many patients report discomfort due to the usage of a tourniquet during the anesthesia process. However, a growing number of physicians are beginning to use the wide awake local anesthesia no tourniquet (WALANT) approach. WALANT utilizes a distal nerve block (commonly Ropivacaine), Lidocaine, Epinephrine, but no tourniquet. The more commonly used approach utilizes the same distal nerve block, in combination with a tourniquet. To date, there have been no systematic reviews or meta-analyses evaluating whether the WALANT approach yields lower pain than a distal nerve block with a tourniquet during CTR.
Purpose: We conducted a systematic review and pooled analysis comparing the WALANT technique to using a tourniquet with a distal nerve block on the pain experienced by patients during carpal tunnel release.
Methods: This systematic review and pooled analysis followed the 2020 PRISMA guidelines. Five online databases (Cochrane, Embase, Scopus, Web of Science, Pubmed) were screened for studies that included intraoperative Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) scores of patients having CTR with either the WALANT approach or a tourniquet with a distal nerve block. After the screening process, 2 randomized controlled trials (RCTs) were included in the final analysis, yielding a total of 90 distinct patient evaluations.
Results: The results portray a strong clinical significance (Cohen’s d = 1.03, 95% CI 0.59-1.47) on pain reduction, in favor of utilizing the WALANT technique.
Conclusion: Our systematic review and pooled analysis serves as a preliminary study in the exploration of the WALANT technique, specifically for CTR. The results illustrate that WALANT is a promising method in reducing patient pain during this procedure, portrayed by the large effect size between using a tourniquet with a distal block, and WALANT. Future RCTs are needed to control for the drug and dose of nerve block used, and to increase the sample size.