Comparative Study, Walant vs Axillary Block in Carpal Tunnel Surgery

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 the length of hospitalization is 4.2 hours (2-6) for the WALANT and 14.2 hours (9-26) for the 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, the WALANT is an alternative to tourniquets in CTS surgeries for obtaining a bloodless surgical field without the discomfort of tourniquet application.