WALANT Technique (Wide Awake Local Anesthesia No Tourniquet) for Carpal Tunnel Release.

NCT04494100 | Completed

• 1 other identifier: 2020/02
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 2

Brief Summary

The carpal tunnel release (CTR) is now performed almost exclusively under regional anesthesia (RA) in France. RA requires the use of a pneumatic tourniquet to limit blood flow to the operated extremity and create a bloodless surgical field for a clear visualization of the anatomic structures by the surgeon. Multiple approaches to block the brachial plexus can be considered. The most common technique is the axillary block (BAX) that provides complete anesthesia for the patient's arm and forearm. This technique offers anesthesia not only for the surgical area but also for the root of the arm where the pneumatic tourniquet is placed. However this technique have limits: the persistence of a motor block in the arm and the forearm that is not compatible with a quick hospital discharge (short term ambulatory hospitalization) and the need for assistance with dressing and eating after surgery. More distal anesthetic techniques are proposed such as the troncular blocks (TRONC) that avoid motor block of the arm and offer an earlier recovery and autonomy for the patient. However, they lead to a poor tolerance to the tourniquet due to its application on a non-anesthetized area.The pain related to the pressure of the tourniquet can occur within the first few minutes of its inflation, get worse over time and persist for several minutes after its deflation. Therefore, TRONC procedure is less often performed compared to the BAX for major surgeries but it remains appropriate for CTR. The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique is widely used in Canada and has been proposed for hand and wirst minor surgeries. WALANT uses a combination of a local anesthetic (LA) and epinephrine to induce anesthesia and hemostasis in the area of the surgical procedure in order to allow surgeries to be done without the use of tourniquet. Epinephrine is a vasoconstrictor agent that reduces blood flow at surgical site. This bloodless effect is visualized on the skin by a pale color. Thus, WALANT can provide a chemical tourniquet and eliminate the pain from a traditional arm tourniquet. However, this technique is performed with a short-acting LA and does not offer any postoperative analgesia. The association of TRONC using long-acting LA with the WALANT technique could combine the comfort of a surgery without tourniquet to a long-acting analgesia and thus could provide a superior overall comfort. The main objective of this prospective, multicentre, randomized, open-label, parallel-group controlled trial is to evaluate the interest of WALANT technique on patient comfort during CTR performed with TRONC, compared to the tourniquet.

Conditions

Carpal Tunnel Release

Keywords

WALANT; Tourniquet; Regional anesthesia; Troncular blocks; Postoperative Analgesia; Ultrasound

Outcome Measures

Primary Outcomes (1)

• Patient comfort during CTR

  Pain score using a Visual Analogue Sclae (VAS) ranging from 0 to 10 (0= completely painless, 10= extremely painfull).

  4 hours

Secondary Outcomes (7)

• Quality of the endoscopic surgical procedure

  4 hours

• Troncular block success

  30 minutes

• WALANT technique success

  30 minutes

• Hemostasis quality for the WALANT group

  4 hours

• Patient satisfaction

  4 hours

Study Arms (2)

CONTROL

ACTIVE COMPARATOR

Troncular blocks using a long-acting LA + Tourniquet

Procedure: TRONC; Procedure: Tourniquet; Drug: Ropivacaine

WALANT

EXPERIMENTAL

Troncular blocks using a long-acting LA + WALANT technique using a short-term LA with epinephrine a vasoconstrictor agent

Procedure: TRONC; Procedure: WALANT; Drug: Ropivacaine; Drug: Lidocaine + Epinephrine

Interventions

TRONC PROCEDURE

injection of 3 to 7 mL of Ropivacaine 3.75 mg/ml per nerve (median and ulnar nerves) and infiltration of 2 ml of Ropivacaine 3.75 mg/ml laterally above the flexion fold of the wrist in order to block the branches of the lateral cutaneous nerve of the forearm, the terminal sensory branch of the musculocutaneous nerve.

CONTROL; WALANT

WALANT PROCEDURE

infiltration with 3 to 7 ml of 1% lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine and 8.4% sodium bicarbonate in the subcutaneous area in front of the transverse ligament, between the thenar and hypothenar eminences, from the flexion fold of the wrist over a length of 5 cm.

WALANT

Tourniquet PROCEDURE

inflation pressure 75 to 100 mmHg above systolic blood pressure.

CONTROL

Ropivacaine DRUG

troncular blocks with Ropivacaine 3.75 mg/ml

CONTROL; WALANT

Lidocaine + Epinephrine DRUG

WALANT technique with 1% lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine

WALANT

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients undergoing endoscopic carpal tunnel release
• Consent for participation
• Affiliation to a social security system

You may not qualify if:

• Chronic pain syndrome or fibromyalgia
• Contraindication for locoregional anesthesia
• ASA 4
• Pregnant or breastfeeding women
• Patients under protection of the adults(guardianship, curators or safeguard of justice)
• Communication difficulties or neuropsychiatric disorder

Sponsors & Collaborators

• CMC Ambroise Paré: lead

Study Sites (2)

Clinique Jouvenet

Paris, Île-de-France Region, 75016, France

Location

Clinique Rémusat

Paris, Île-de-France Region, 75016, France

Location

Related Publications (1)

• Bloc S, Squara P, Quemeneur C, Doirado M, Thomsen L, Merzoug M, Naudin C, Le Sache F. Wide Awake Local Anesthesia No Tourniquet (WALANT) technique improves the efficiency of distal nerve blocks for carpal tunnel release. Anaesth Crit Care Pain Med. 2023 Aug;42(4):101229. doi: 10.1016/j.accpm.2023.101229. Epub 2023 Apr 7.

  PMID: 37031817 RESULT

MeSH Terms

Interventions

Tourniquets; Ropivacaine; Lidocaine; Epinephrine

Intervention Hierarchy (Ancestors)

Equipment and Supplies; Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines; Acetanilides; Ethanolamines; Amino Alcohols; Alcohols; Biogenic Monoamines; Biogenic Amines; Catecholamines; Catechols; Phenols; Benzene Derivatives; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 28, 2020
• First Posted: July 31, 2020
• Study Start: September 11, 2020
• Primary Completion: June 25, 2021
• Study Completion: July 5, 2021
• Last Updated: April 8, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

FR (2)