gms | German Medical Science

Objectives/Interrogation: Regional intravenous anesthesia (Bier block) has been used for carpal tunnel surgery (CTS). Recently, wide awake local anesthesia no tourniquet (WALANT) has been increasing its popularity for many hand surgery procedures. We aimed to compare patients' CTS experience with two different anesthesia methods.

Methods: Patients' CTS were performed either with WALANT (epinephrine 1:100.000, lidocaine 1%, bicarbonate %8.4) or with Bier block (lidocaine 1%, bicarbonate %8.4) anesthesia methods. Patients were requested to fill patients' satisfaction form after the surgery. In the form; patients' were appealed to quantify their pain levels on visual analog scale (VAS), asked to compare the operation with dental procedures and their expectations, and questioned for their desires about re-operation with the same anesthesia method. The results were compared for two anesthesia methods.

Results and Conclusions: There were 54 cases operated with WALANT and 34 cases operated with Bier block anesthesia methods (72 patients, 16 bilateral). There were no significant differences between mean ages (WALANT 50.9, Bier block 52.4) and median VAS (during local anesthesia injection, during surgery, and during the postoperative first day) of the two groups. Bier block patients reported moderate (median VAS score 5) tourniquet pain. When compared with dental procedures; 90.7% (49/54) of WALANT patients, and 42.4% (14/33, one patient reported to have no dental experience) of Bier block patients reported the CTS to be an easier procedure (p<0.0001). When compared with patients' expectations; none 94.4% (51/54) of WALANT patients, and 52.9% (18/34) of Bier block patients reported the CTS to be an easier procedure than they expected (p<0.0001). For the re-operation when needed; 96.3% (52/54) of WALANT patients, and 41.2% (14/34) of Bier block patients reported their desire for the same anesthesia method (p<0.0001). Thirteen patients who were operated bilaterally (one side with WALANT, and the contralateral side with Bier block) were asked for their anesthesia choice; 11 preferred WALANT, one preferred RIVA, and one reported no difference. Three patients were operated bilaterally with WALANT for their both hands because they did not accept operation with RIVA.

WALANT anesthesia method offers a better patients' satisfaction for CTS than Bier block. This is mostly related to tourniquet pain of Bier block patients. Nowadays, many surgeons prefer WALANT anesthesia for a wide variety of hand surgery procedures.