WALANT Versus Local Anesthesia With Tourniquet for Carpal Tunnel Decompression

NCT07617064 | Completed

• 1 other identifier: WALANTvsLAT-CTD-RCT-01
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 2

Brief Summary

This multicenter, randomized, double-blinded controlled trial compared two local anesthetic techniques for open carpal tunnel decompression in adults. The wide-awake local anesthesia no tourniquet (WALANT) technique uses lidocaine with epinephrine and no tourniquet, whereas the conventional technique uses lidocaine only with a pneumatic tourniquet (LA-T). One hundred adults with carpal tunnel syndrome were randomized 1:1 to WALANT or LA-T at two tertiary university hospitals in Egypt. The primary objective was to compare intraoperative pain during surgery. Secondary objectives included pain during infiltration, tourniquet pain (LA-T only), operative time, patient satisfaction, and intraoperative complications.

Conditions

Carpal Tunnel Syndrome

Keywords

Carpal tunnel release; Wide-awake local anesthesia no tourniquet; WALANT; Local anesthesia with tourniquet; Hand surgery; Intraoperative pain; Patient satisfaction

Outcome Measures

Primary Outcomes (1)

• Intraoperative Pain (VAS)

  "Overall intraoperative pain scored by the patient using a visual analog scale (VAS) from 0 (no pain) to 10 (worst imaginable pain). The patient rated the overall pain experienced during surgery on a standardized questionnaire administered by a blinded assessor."

  Intraoperative.

Secondary Outcomes (5)

• Infiltration Pain (VAS)

  Perioperative " During local anesthetic injection, assessed immediately after infiltration."

• Tourniquet Pain (VAS) - LA-T Group Only

  Perioperative " During tourniquet inflation, assessed after the primary intraoperative pain rating."

• Operative Time

  Intraoperative (from first skin incision to final skin closure).

• Patient Satisfaction With Operating Room Experience

  Day 1 Postoperative

• Intraoperative Complications

  Baseline up to 30 days postoperatively.

Study Arms (2)

WALANT (Wide-Awake Local Anesthesia No Tourniquet)

EXPERIMENTAL

"Patients received wide-awake local anesthesia with epinephrine infiltration in the operative field, without arm tourniquet or routine sedation, for open carpal tunnel decompression."

Procedure: WALANT technique for carpal tunnel decompression

Local Anesthesia With Tourniquet (LA-T)

ACTIVE COMPARATOR

"Patients received buffered lidocaine without epinephrine and an upper-arm pneumatic tourniquet for open carpal tunnel decompression."

Procedure: Local anesthesia with tourniquet for carpal tunnel decompression

Interventions

WALANT technique for carpal tunnel decompression PROCEDURE

"Twenty milliliters of 1% lidocaine (200 mg) with epinephrine 1:100,000, buffered with 8.4% sodium bicarbonate at a 10:1 ratio, were infiltrated into the operative field approximately 20 minutes before incision. No tourniquet was applied. A mini-open CTD through a 2-3 cm incision was performed in a minor procedure room under full aseptic technique. Hemostasis relied on epinephrine-mediated vasoconstriction and meticulous surgery."

WALANT (Wide-Awake Local Anesthesia No Tourniquet)

Local anesthesia with tourniquet for carpal tunnel decompression PROCEDURE

"Twenty milliliters of 1% lidocaine (200 mg) buffered identically to the WALANT solution but without epinephrine were infiltrated approximately 5 minutes before incision in the operating room. A blood pressure cuff tourniquet was placed above the elbow, inflated to 100 mmHg above systolic pressure after arm elevation and draping, and released after wound closure. Mini-open CTD was performed through a 2-3 cm incision under standard aseptic conditions."

Local Anesthesia With Tourniquet (LA-T)

Eligibility Criteria

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

You may qualify if:

• Adults (≥18 years) with clinically and electrophysiologically confirmed carpal tunnel syndrome.
• Candidate for surgical treatment with open carpal tunnel decompression.
• American Society of Anesthesiologists (ASA) physical status I or II.
• Able and willing to provide written informed consent.

You may not qualify if:

• Surgery-related anxiety requiring sedation or general anesthesia.
• Known contraindication or allergy to lidocaine or epinephrine.
• Active local or systemic infection at or near the surgical site.
• ASA physical status III or higher.
• Pregnancy or breastfeeding.
• Any condition preventing reliable pain scoring or follow-up according to investigator judgment.

Sponsors & Collaborators

• Misr University for Science and Technology: lead

Study Sites (2)

Al-Azhar University Hospital (Neurosurgery Department)

Cairo, Egypt

Location

Misr University for Science and Technology Hospital (Orthopedic Surgery Department)

Giza, Egypt

Location

MeSH Terms

Conditions

Carpal Tunnel Syndrome; Patient Satisfaction

Interventions

Anesthesia, Local; Tourniquets

Condition Hierarchy (Ancestors)

Median Neuropathy; Mononeuropathies; Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Nerve Compression Syndromes; Cumulative Trauma Disorders; Sprains and Strains; Wounds and Injuries; Treatment Adherence and Compliance; Health Behavior; Behavior

Intervention Hierarchy (Ancestors)

Anesthesia, Conduction; Anesthesia; Anesthesia and Analgesia; Equipment and Supplies

Study Officials

• Mohammed S.K. Hamza, MD, PhD

  Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Orthopaedics surgery

Study Record Dates

• First Submitted: May 17, 2026
• First Posted: June 1, 2026
• Study Start: September 1, 2024
• Primary Completion: December 13, 2025
• Study Completion: December 15, 2025
• Last Updated: June 1, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

EG (2)