Wide-Awake Local Anesthesia Matches Nerve Block and Improves Comfort in Carpal Tunnel Release: Study
France: A prospective, double-blind randomized trial has found that wide-awake local anesthesia without a tourniquet provides anesthetic success equal to an ultrasound-guided axillary brachial plexus block for outpatient endoscopic carpal tunnel release. It also better preserves immediate hand function and improves patient comfort.
Published in Regional Anesthesia & Pain Medicine, the study—led by Marie Virtos from the Department of Anesthesiology at Clinique Medipole Garonne in Toulouse, France—evaluated whether the increasingly popular Wide Awake Local Anesthesia No Tourniquet (WALANT) technique could match the performance of the traditional ultrasound-guided axillary block (USGAB) during endoscopic carpal tunnel release. As WALANT becomes more widely used for hand and wrist procedures, clinicians have sought stronger evidence confirming its effectiveness and safety compared with established regional anesthesia methods.
The trial was designed as a prospective, double-blind, non-inferiority study. It included 130 patients scheduled for outpatient endoscopic carpal tunnel surgery. Participants were randomly assigned to receive either WALANT or USGAB, with both groups administered lidocaine as the local anesthetic. The primary measure of interest was the ability of each technique to provide sufficient anesthesia for surgery without requiring supplemental medication or conversion to another approach.
Key Findings:
- The WALANT technique achieved a 100% anesthetic success rate, compared with 89% in the USGAB group.
- Non-inferiority of WALANT relative to USGAB was statistically confirmed.
- Surgeons reported no significant difference in intraoperative bleeding between the two anesthesia methods, indicating that avoiding a tourniquet did not affect the surgical field.
- Overall postoperative function was similar for both groups, except for dressing ability, which was markedly better in the WALANT group (92% vs 58%).
- WALANT patients experienced less discomfort, despite overall satisfaction scores being similar across groups, highlighting better comfort with the wide-awake technique.
The researchers concluded that WALANT is at least as effective as ultrasound-guided axillary block for anesthesia during endoscopic carpal tunnel release and offers additional benefits in early functional recovery and comfort. With no increase in bleeding risk and high rates of anesthetic reliability, the findings strengthen the case for WALANT as a practical, patient-friendly alternative to regional nerve blocks in hand surgery.
"As healthcare systems increasingly prioritize minimally invasive, efficient, and patient-centered procedural care, WALANT may continue to expand its role in outpatient upper-limb surgery," the authors wrote.
Reference:
Virtos M, Chassery C, Marty P, et alWide awake local anesthesia no tourniquet (WALANT) versus ultrasound-guided axillary block in carpal tunnel release: a non-inferiority randomized controlled trialRegional Anesthesia & Pain Medicine Published Online First: 13 November 2025. doi: 10.1136/rapm-2025-107152
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