Wide awake Anesthesia Proves Effective for Carpal Tunnel Release, suggests study
A new study published in the journal of BMC Surgery found that for carpal tunnel release (CTR), WALANT (Wide Awake Local Anesthesia No Tourniquet) was a quick and efficient anesthetic method that offered sustained pain relief without compromising grip strength, functional recovery, or sleep quality.
For carpal tunnel release, wide-awake local anesthesia without a tourniquet (WALANT) has become a viable substitute for conventional regional anesthetic. It shortens recuperation time, removes the possibility of anesthesia, and permits intraoperative evaluation of hand function. For patients who would rather have an entirely insensate operating field, regional anesthetic provides better pain management. Thus, this study compared their effects on grip strength, pain, functional recovery, and sleep quality.
62 patients receiving CTR under WALANT or ABPB participated in a prospective observational research with quasi-randomization. The Pittsburgh Sleep Quality Index (PSQI), grip strength, and the Visual Analog Scale (VAS) for pain were among the outcomes. Following surgery, patients were monitored for one week, three weeks, and three months.
When compared to ABPB, WALANT considerably shortened the operating time (mean: 20.8 ± 4.1 min vs. 41.5 ± 9.4 min; mean difference: 20.7 min; 95% CI: 16.3–25.1; p = 0.001; d = 2.45). Additionally, it was linked to noticeably decreased pain levels at three weeks and 3 months. VAS ratings were 0.7±0.8 (WALANT) vs. 2.5±2.1 (ABPB) at 3 weeks (mean difference: 1.8; 95% CI: 0.6–2.9; p = 0.003; d = 1.00) and 0.3±0.4 vs. 2.3±1.4 at 3 months (mean difference: 2.0; 95% CI: 1.1–2.9; p = 0.003; d = 1.15).
The WALANT group also had decreased early postoperative pain assessments (first hour and first day), although these differences were not statistically significant. Thumb pinch and finger pinch assessments of grip strength recovery at three months did not significantly differ between groups (p > 0.05). Similarly, at 3 months, there was no significant difference between the groups' improvements in sleep quality as measured by PSQI (WALANT: 5.7 ± 1.6 vs. ABPB: 5.9 ± 1.3; p = 0.868).
Overall, these results illustrate the complexity of sleep disturbances in CTS patients by showing that variables other than pain treatment have an impact on postoperative sleep recovery. All groups showed similar grip strength recovery, which supports the idea that the kind of anesthesia has no direct bearing on the recovery of motor function following CTR.
Reference:
Bayrak, A., Yalın, M., Tıngır, M., Çatal, T., Öztürk, V., & Koluman, A. C. (2025). Wide-awake vs. regional anesthesia for carpal tunnel release: a prospective study on pain, grip strength, and sleep quality. BMC Surgery, 25(1), 520. https://doi.org/10.1186/s12893-025-03275-z
