Article ; Online: Safety and efficacy of a modified WALANT technique using undiluted adrenaline during open surgical carpal tunnel release: a prospective report of 308 procedures.
Journal of orthopaedic surgery and research
2023 Volume 18, Issue 1, Page(s) 875
Abstract: Purpose: The current study aimed to report on the safety and efficacy of utilizing a modified WALANT (mWALANT) technique during open surgical carpal tunnel release (CTR), where we used undiluted epinephrine compared to the originally described WALANT ... ...
| Abstract | Purpose: The current study aimed to report on the safety and efficacy of utilizing a modified WALANT (mWALANT) technique during open surgical carpal tunnel release (CTR), where we used undiluted epinephrine compared to the originally described WALANT technique. Methods: From January 2015 till the end of June 2021, 200 patients (175 (87.5%) were females) who presented with carpal tunnel syndrome, either bilateral (108 (54%) patients) or unilateral (92 (46%)) were included, formulating a total of 308 procedures. Open surgical CTR was performed as a daycare procedure by the same surgeon. The mWALANT injectable mixture was prepared by mixing 8 CC of 2% lidocaine HCl + 1 CC of 0.25 mg/1 ml epinephrine without dilution (2.5 times the concentration used in the original WALANT technique). The injection was performed before draping. Results: The patients' average age at surgery was 42.88 ± 13.03 years old; they were followed up for an average of 31 ± 17.17 months. The average operative time was 9.5 ± 1.87 min. None (0.0%) of the patients needed top-up of local anesthesia or shift into general anesthesia, and no (0.0%) patients needed postoperative hospital stay. The average VAS during the surgical procedure was 2.5 ± 2.1, mainly reported during infiltration of the local anesthesia; no patients reported discomfort during the surgical procedure itself. 180 (90%) patients reported a full return to their usual preoperative ADL after an average of 4.7 ± 1.2 weeks. No (0.0%) postoperative fingers ischemic or temperature changes. Two (1%) patients experienced an adrenaline rush in the form of tachycardia that needed sedation and close monitoring by the anesthesiologist; they were discharged on the same day. One (0.5%) patient (who had uncontrolled diabetes mellitus) showed a superficial wound infection which resolved after conservative management. Conclusions: Using undiluted epinephrine during the mWALANT technique is safe and effective. There is no need to wait until the drugs fully function, and no epinephrine-related complications were encountered apart from occasional adrenaline rush symptoms. |
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| MeSH term(s) | Female ; Humans ; Adult ; Middle Aged ; Male ; Epinephrine ; Carpal Tunnel Syndrome/surgery ; Prospective Studies ; Anesthesia, Local/methods ; Anesthesia, General |
| Chemical Substances | Epinephrine (YKH834O4BH) |
| Language | English |
| Publishing date | 2023-11-17 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 2252548-8 |
| ISSN | 1749-799X ; 1749-799X |
| ISSN (online) | 1749-799X |
| ISSN | 1749-799X |
| DOI | 10.1186/s13018-023-04369-1 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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