The wide awake local anesthesia no tourniquet (WALANT) approach has better efficacy than the intravenous regional anesthesia (IVRA; Bier's block) approach for carpal tunnel syndrome surgery.

This randomized clinical trial was carried out for determining the efficacy of the WALANT technique vs. IVRA technique for the surgical management of carpal tunnel syndrome.

Overall, 78 adult patients presenting with idiopathic carpal tunnel syndrome without prior hand surgery were incorporated in this study and were randomized to receive either the WALANT technique (n = 40) or IVRA technique (n = 38). The major endpoint was an estimation of perioperative pain with the aid of visual analogue scale (VAS). The Boston Questionnaire score, Hospital Anxiety and Depression Scale score, operating room times, complications, requirement for the use of analgesics, anesthetic failure rate, and remission of paresthesia were the secondary endpoints ascertained.

The WALANT technique demonstrated superiority to the IVRA technique, particularly to control intraoperative and postoperative pain. Participants receiving IVRA technique were found to spend more time in the operating room and required more number of analgesics. Five IVRA procedures failed, as shown in Table 1:

Compared to the IVRA technique, the WALANT technique is superior in terms of pain control, time spent in the operating room, usage of analgesic in the postsurgery period and the anesthetic failure rate.