Safe Use of WALANT Technique for Safe WALANT Technique for Mini-Open Ulnar Nerve Decompression at Elbow Safe surgicaloption: Study

Dr Supreeth  D R

Safe Use of WALANT Technique for Safe WALANT Technique for Mini-Open Ulnar Nerve Decompression at Elbow Safe surgicaloption: Study

Written By : Dr Supreeth D R Published On 2025-09-30T20:45:23+05:30 | Updated On 1 Oct 2025 3:25 PM IST

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.’

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.