WALANT versus intravenous regional anesthesia for carpal tunnel syndrome: a randomized clinical trial

ABSTRACT BACKGROUND: There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the "wide awake local anesthesia no tourniquet" (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques. OBJECTIVE: To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier's block), for surgical treatment of CTS. DESIGN AND SETTING: Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications. RESULTS: The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06). CONCLUSIONS: The WALANT technique is more effective than IVRA for CTS surgery.

WALANT versus intravenous regional anesthesia for carpal tunnel syndrome: a randomized clinical trial.

BACKGROUND: There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the "wide awake local anesthesia no tourniquet" (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques. OBJECTIVE: To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier's block), for surgical treatment of CTS. DESIGN AND SETTING: Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications. RESULTS: The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06). CONCLUSIONS: The WALANT technique is more effective than IVRA for CTS surgery.

Estudo prospectivo randomizado comparativo do tratamento da doença de De Quervain com corticosteróide associado a terapias complementares

Comparou-se três formas de tratamento para doença de De Quervain: somente infiltração com corticosteróide, infiltração com corticosteróide associada à imobilização com órtese e infiltração com corticosteróide associado à fisioterapia. O grupo submetido ao tratamento associado de infiltração e fisioterapia apresentou melhora clínica superior aos demais grupos, os quais mostraram resultados semelhantes e melhora clínica menos acentuada. Do total de pacientes, dezessete (23,8%) não se beneficiaram do tratamento clínico e foram encaminhados para procedimento cirúrgico. Conclusão: A associação terapêutica de corticosteróides e fisioterapia foi comprovadamente superior à utilização de infiltração com ou sem imobilização para pacientes portadores da doença de De Quervain

Estudo prospectivo randomizado comparativo do tratamento da doença de De Quervain com corticosteróide associado a terapias complementares / A randomized study comparing the treatment of de Quervain disease with corticosteroids associated with complementary therapies

Comparou-se três formas de tratamento para doença de De Quervain: somente infiltração com corticosteróide, infiltração com corticosteróide associada à imobilização com órtese e infiltração com corticosteróide associado à fisioterapia. O grupo submetido ao tratamento associado de infiltração e fisioterapia apresentou melhora clínica superior aos demais grupos, os quais mostraram resultados semelhantes e melhora clínica menos acentuada. Do total de pacientes, dezessete (23,8%) não se beneficiaram do tratamento clínico e foram encaminhados para procedimento cirúrgico. Conclusão: A associação terapêutica de corticosteróides e fisioterapia foi comprovadamente superior à utilização de infiltração com ou sem imobilização para pacientes portadores da doença de De Quervain (AU)