Open cubital and carpal tunnel release using wide-awake technique: reduction of postoperative pain
Received 28 March 2019
Accepted for publication 29 August 2019
Published 16 September 2019 Volume 2019:12 Pages 2725—2731
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Katherine Hanlon
Sang-Woo Kang,1 Hye-Mi Park,2 Ji-Kang Park,1 Ho-Seung Jeong,1 Jung-Kwon Cha,1 Ban-Suk Go,1 Kyoung-Tae Min1
1Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, South Korea; 2Department of Psychiatry, Chungbuk National University Hospital, Cheongju, South Korea
Correspondence: Ji-Kang Park
Department of Orthopaedic Surgery, Chungbuk National University Hospital, Mailing address: 776-1 Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea
Tel +82 43 269 6077
Fax +82 43 274 8719
Purpose: This study aimed to compare the efficacy of and patient satisfaction with the wide-awake local anesthesia with no tourniquet (WALANT) technique in open cubital and carpal tunnel release surgery.
Methods: From January 2016 to February 2017, 20 cubital tunnel syndrome (CuTS) patients were in a wide-awake (WA) group and 22 in a general (GA) anesthesia group in . Also, 20 carpal tunnel syndrome (CTS) patients were in a WA group, 22 in a local anesthesia (LA) group, and 20 in a GA group. Injection pain, perioperative pain, and postoperative pain were assessed using a 10-point pain VAS. In CuTS, functional outcome on the “quick” Disabilities of the Arm, Shoulder, and Hand questionnaire were evaluated. In CTS, subjective outcomes were assessed using the Korean version of the Michigan Hand Outcomes Questionnaire.
Results: Both CuTS and CTS showed significant postoperative pain reduction in group WA. In CuTS, group WA had less pain than group GA up to 48 hours after surgery (P<0.05). Supplemental opioid injections were used on hospitalization day by 12% of group WA and 35% of group GA. In CTS, the postoperative VAS scores in group WA were lower during the first 24 hours than groups LA and GA (P<0.05). Opioid injections were used on hospitalization day by 5% of WA, 18% of LA, and 32% of group GA. There was no difference in postoperative functional outcomes according to anesthesia method in CuTS or CTS.
Conclusion: Cubital and carpal tunnel surgery using the WALANT technique was comparable in function to other anesthesia methods and superior for pain. Immediate postoperative pain was much lower than other groups, which could reduce the use of opioids during hospitalization.
Keywords: cubital tunnel syndrome, carpal tunnel syndrome, wide-awake surgery, opioid
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