Gerardo Gallucci - ۱ Instituto de Ortopedia y Traumatología “Carlos E. Ottolenghi”. Servicio de Ortopedia y Traumatología Hospital Italiano de Buenos Aires, Argentina ۲ Centro de Ortopedia y Traumatología Quilmes, Buenos Aires,
Yanina Rosa - Centro de Ortopedia y Traumatología Quilmes, Buenos Aires, Argentina
Walter Cerrutti - Centro de Ortopedia y Traumatología Quilmes, Buenos Aires, Argentina
Ignacio Tanoira - Instituto de Ortopedia y Traumatología “Carlos E. Ottolenghi”. Servicio de Ortopedia y Traumatología Hospital Italiano de Buenos Aires, Argentina
Ignacio Rellan - Instituto de Ortopedia y Traumatología “Carlos E. Ottolenghi”. Servicio de Ortopedia y Traumatología Hospital Italiano de Buenos Aires, Argentina

Objectives: Obtaining a blood-free surgical field is critical during carpal tunnel decompression (CTD) to identify anatomic structures and avoid iatrogenic injury. A tourniquet is often used to minimize bleeding and improve visualization. However, it may be associated with discomfort and intolerance when sedation is not employed. WALANT ("Wide awake local anesthesia no tourniquet") technique surgeries have become very popular and enable the patient to be involved in the procedure; in addition, the adrenaline avoids the use of the tourniquet and the discomfort it produces. We hypothesized that there is no difference in postoperative pain after CTD between local anesthetic with a tourniquet (LA-T) and WALANT technique. The objective of this paper is to report the results of CTD, comparing those performed with local anesthesia and those performed with the WALANT.Methods: In this prospective study, ۶۰ CTS were operated in two different institutions. Patients in group ۱ (۳۰ patients) were operated under LA-T, while patients in group ۲ (۳۰patients) were operated on using lidocaine with epinephrine (WALANT). Statistical analysis was performed.Results: Postoperative pain immediately after surgery, at ۴ and ۲۴ hours, and ۱۵, and ۳۰ days after surgery; and degree of satisfaction did not show a significant difference between the two groups. Moreover, surgical time was slightly shorter in the LA-T group, but the difference was not significant.Conclusion: In our study, CTD performed with LA-T, and WALANT technique resulted in similar results. In cases of experienced surgeons, LA-T may be enough to perform the procedure, avoiding epinephrine's low but complex complications. In less experienced surgeons who require more surgical time, the use of WALANT may increase the intraoperative comfort of the patient.  Level of evidence: IV

Carpal tunnel syndrome, epinephrine, local anesthesia, Tourniquet, Walnat