Wide-Awake Local Anesthesia No Tourniquet (WALANT) has expanded its applications over the past decade from common hand procedures to a broader range of more complex surgeries.
However, despite its frequent use, there is limited literature on WALANT for cubital tunnel syndrome. Ignacio Rellán et al adapted a mini-open approach which characterized by a smaller incision while preserving its blood supply. The article has been published in ‘Indian Journal of Orthopaedics.’
The objective of article was to describe this two-stage local anesthetic injection method that has enabled to safely and successfully treat 16 patients without complications.
The authors conducted a retrospective cohort study. Sixteen patients meeting specific inclusion criteria underwent ulnar nerve decompression under WALANT. Patients were preoperatively classified according to Dellon’s classification. Surgical technique included a staged local anesthetic solution infiltration and careful dissection to preserve nerve stability.
The key findings of the study
• Preoperative classification revealed six mild, six moderate, and four severe cases.
• Intraoperative discomfort was reported by four patients before incorporating a second stage of distal local anesthetic infiltration.
• All patients exhibited stable intraoperative ulnar nerve positioning and were discharged independently 20 min post-surgery.
• Follow-up at an average of 12 weeks (range 10 -18 weeks) showed symptom resolution in all patients.
• No complications, including iatrogenic injury to medial antebrachial cutaneous nerve branches, were reported.
The authors concluded - ‘ulnar nerve decompression at the elbow using a mini-open approach can be safely performed with the WALANT technique. We recommend having access to an electrocautery during this procedure, as operating with WALANT through a mini approach can result in subtle bleeding from some vessels, which might obstruct vision. Additionally, we suggest performing your initial cases in a conventional operating room with an anesthesiologist present to become familiar with it. Incorporating a staged local anesthetic infiltration enhances patient comfort.’
Further reading:
Treatment of Cubital Tunnel Syndrome Under WALANT Technique Through a Mini-Open Approach: Surgical Technique and Case Series with Short-Term Follow-up Ignacio Rellán et al Indian Journal of Orthopaedics (2025) 59:659–666 https://doi.org/10.1007/s43465-025-01362-0
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