WALANT Technique (Wide Awake Local Anesthesia No Tourniquet) for Carpal Tunnel Release.
Status:
Completed
Trial end date:
2021-07-05
Target enrollment:
Participant gender:
Summary
The carpal tunnel release (CTR) is now performed almost exclusively under regional anesthesia
(RA) in France. RA requires the use of a pneumatic tourniquet to limit blood flow to the
operated extremity and create a bloodless surgical field for a clear visualization of the
anatomic structures by the surgeon.
Multiple approaches to block the brachial plexus can be considered. The most common technique
is the axillary block (BAX) that provides complete anesthesia for the patient's arm and
forearm. This technique offers anesthesia not only for the surgical area but also for the
root of the arm where the pneumatic tourniquet is placed. However this technique have limits:
the persistence of a motor block in the arm and the forearm that is not compatible with a
quick hospital discharge (short term ambulatory hospitalization) and the need for assistance
with dressing and eating after surgery. More distal anesthetic techniques are proposed such
as the troncular blocks (TRONC) that avoid motor block of the arm and offer an earlier
recovery and autonomy for the patient. However, they lead to a poor tolerance to the
tourniquet due to its application on a non-anesthetized area.The pain related to the pressure
of the tourniquet can occur within the first few minutes of its inflation, get worse over
time and persist for several minutes after its deflation. Therefore, TRONC procedure is less
often performed compared to the BAX for major surgeries but it remains appropriate for CTR.
The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique is widely used in Canada and
has been proposed for hand and wirst minor surgeries. WALANT uses a combination of a local
anesthetic (LA) and epinephrine to induce anesthesia and hemostasis in the area of the
surgical procedure in order to allow surgeries to be done without the use of tourniquet.
Epinephrine is a vasoconstrictor agent that reduces blood flow at surgical site. This
bloodless effect is visualized on the skin by a pale color. Thus, WALANT can provide a
chemical tourniquet and eliminate the pain from a traditional arm tourniquet. However, this
technique is performed with a short-acting LA and does not offer any postoperative analgesia.
The association of TRONC using long-acting LA with the WALANT technique could combine the
comfort of a surgery without tourniquet to a long-acting analgesia and thus could provide a
superior overall comfort.
The main objective of this prospective, multicentre, randomized, open-label, parallel-group
controlled trial is to evaluate the interest of WALANT technique on patient comfort during
CTR performed with TRONC, compared to the tourniquet.