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Open Carpal Tunnel Release Outcomes: Performed with MAC v WALANT
Tulipan Jacob, MD; Jonas Matzon, MD; Asif Ilyas, MD
Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: To evaluate open carpal tunnel release (CTR) using wide-awake, local anesthesia, no tourniquet (WALANT) anesthesia versus local anesthesia with sedation and a tourniquet (MAC). We hypothesize that patient outcomes and patient satisfaction will be equivalent in both groups.

Methods: Consecutive cases of EMG-confirmed open CTR were prospectively enrolled. Data collected included demographic data, EMG severity, surgical characteristics, Visual Analog Scale, Levine-Katz carpal tunnel syndrome scale, QuickDASH questionnaire, and a customized Likert scale. Descriptive statistics were performed.

Results: A total of 230 consecutive patients were enrolled. There were 81 patients in the WALANT group and 149 patients in the MAC group. There were no re-operations in either group nor any epinephrine-related complications in the WALANT group. Disability and symptom scores did not differ significantly between WALANT and sedation groups at either postoperative time point. Average postoperative QuickDASH scores were 34.4 versus 36.7 for WALANT versus MAC groups, respectively (p>0.05). Average postoperative Levine-Katz scores were 1.27 versus 1.29 for WALANT versus MAC groups, respectively (p>0.05). Average VAS pain score were 4.7 versus 4.2 was 4.7 for WALANT versus MAC groups, respectively (p>0.05). Both groups of patients reported high levels of satisfaction at 91% versus 96% for the WALANT versus MAC groups, respectively (p>0.05). Patients in each group were likely to have the similar anesthesia if they were to undergo surgery again.

Conclusion: Patients undergoing Open CTR experience similar levels of satisfaction and outcomes with either WALANT or MAC techniques. There was no statistically significant difference between either group relative to complications, VAS pain scores, Levine-Katz and QuickDASH questionnaires, and Likert responses. There were no epinephrine related complications in the WALANT group. This data should facilitate surgeons and patients to choose freely between WALANT and MAC techniques relative to complications and outcomes.

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