Carpal Tunnel Decompression Under Wide Awake Local Anaesthesia No Tourniquet Technique (WALANT): A Cost Effective and Outcome Analysis

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Abstract

Introduction

Wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, resource-friendly, and safe. This can be used as an alternative to hand surgery procedures in outpatient units. It can be performed in clinics or operating rooms.

Methods

We retrospectively evaluated the outcomes of WALANT for carpal tunnel decompression (CTD) over two years. Measured results include wound infections, relief of symptoms, paraesthesia, haematoma, Visual Analogue Scale (VAS), hospital anxiety and depression scale score (HADS) and cost-effectiveness.

Results

Eighteen patients underwent CTD under the WALANT technique over two years. VAS score was recorded at 3.1 ± 1.2 during the procedure and 1.67 ± 0.933 at two weeks follow-up. Persistent paraesthesia was found in only one patient at follow-up. Minimal bleeding was recorded during the procedure. No wound infections, revision surgery or post-operative haematoma formation were found. Hospital Anxiety and Depression Scale (HADS) was reported as 4.77 ± 2.1 after surgery. WALANT was also cost-effective, with an overall amount of £20.

Conclusion

Performing carpal tunnel decompression under WALANT in one stop upper limb clinic is a safe and cost-effective technique with no significant patient-related complications.

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Most cited references 15

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Prevalence of carpal tunnel syndrome in a general population.

Isam Atroshi, Jonas Ranstam (1999)

Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. To estimate the prevalence of CTS in a general population. General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). A region in southern Sweden with a population of 170000. A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.

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Elective surgery in the time of COVID-19

Adrián Díaz, Benjamin Sarac, Anna Schoenbrunner … (2020)

The COVID-19 pandemic has placed a significant strain on the United States health care system, and frontline healthcare workers are rapidly altering their professional responsibilities to help meet hospital needs. In an effort to decrease disease transmission and conserve personal protective equipment (PPE), surgeons have witnessed one of the most dramatic changes in their practices with rapidly decreasing numbers of elective surgeries.

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Evaluation of preoperative anxiety and fear of anesthesia using APAIS score

Fatma Celik, Ipek S. Edipoglu (2018)

Background Preoperative anxiety is one of the most important problems for the patients, because it causes emotional and psychiatric problems as well as physical problems. It is crucial to detect the patient’s existing anxiety to assist patients. Our primary aim in this study is to investigate how the patient’s age, gender, the operation, surgical briefing, type of anesthesia recommended for the operation ahead, and patient’s prior anesthesia experience affect the patient’s anxieties. Our secondary aim is to reveal the causes of the patient’s anxieties regarding anesthesia. Methods Our study was conducted as a prospective cohort study between May 2016–2017. Interviews with the patients were performed in the anesthesia clinic for preoperative examination. For the study, The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has been used. The answers were evaluated in two scales: the anxiety score and the desire for information score. Answers to the statements were evaluated with Likert Scale. In addition, our patients were asked whether they had received prior anesthesia, if so, the type of anesthesia, whether they received surgical briefing and anesthetic method we recommended. We also asked our patients about the cause of their anxiety regarding the anesthesia. Results A total of 637 patients were recruited to the study, after excluding the patients who do not meet the criteria for inclusion, and 499 patients were included. Between the age and desire for information sub-scores, a negative significant correlation was detected (r: − 0.241; p = 0.001). We found that the scores of graduates of university and higher were statistically significant than the primary school graduates (p = 0.003) and secondary school graduates (p = 0.034). Anxiety sub-scores of the patients who underwent general anesthesia were found to be significantly higher than the patients who underwent regional anesthesia (p = 0.029). Anxiety sub-scores of females were found to be significantly higher than the males (p = 0.001). Conclusions We think that being aware of the patients’ anxiety and finding appropriate approaches for their anxieties can be valuable. APAIS is an effective method to measure patient anxiety and it might be beneficial to use during preoperative visits. Patient satisfaction and superior outcomes can be achieved in this way. Trial registration ISRCTN43960422. Registered 19/02/2018—Retrospectively registered. http://www.isrctn.com/ISRCTN43960422

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 19 July 2023

Publication date (Electronic, collection): July 2023

Volume: 15

Issue: 7

Electronic Location Identifier: e42125

Affiliations

[1 ] Trauma and Orthopaedics, North Cumbria Integrated Care, Carlisle, GBR

[2 ] Trauma and Orthopaedics, University of Central Lancashire, Carlisle, GBR

[3 ] Trauma and Orthopaedics, Whiston Hospital, Liverpool, GBR

[4 ] Trauma and Orthopaedics, Redcliffe Hospital, Oxford, GBR

[5 ] Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR

[6 ] Trauma and Orthopaedics, Cumberland Infirmary, Carlisle, GBR

Author notes

Ahmad Faraz farazsurgeon91@ 123456icloud.com

Article

DOI: 10.7759/cureus.42125

PMC ID: 10437000

PubMed ID: 37602033

SO-VID: 5b8d6cb6-3ee6-436d-b067-f6bd57391c17

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date accepted : 19 July 2023

Carpal Tunnel Decompression Under Wide Awake Local Anaesthesia No Tourniquet Technique (WALANT): A Cost Effective and Outcome Analysis

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Most cited references 15

Prevalence of carpal tunnel syndrome in a general population.

Elective surgery in the time of COVID-19

Evaluation of preoperative anxiety and fear of anesthesia using APAIS score

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