WALANT Procedure in Carpal Tunnel Release
Condition: Carpal Tunnel; Median Nerve Neuralgia; Anesthesia, Local
MeSH terms: Carpal Tunnel Syndrome; Neuralgia; Median Neuropathy
Study type: Interventional

Summary: 
      The possible benefits expected from the use of the WALANT procedure are a decrease in
      intraoperative pain at the surgical site, a decrease in hospitalization time, and a decrease
      in the time required to lift the anesthesia postoperatively.

      The risks identified are those inherent to each type of anesthesia (WALANT or traditional
      ALR), as encountered in current practice, and are therefore not specific to the study: risks
      related to the local anesthetic agent or risks related to the puncture procedure.

      The main objective is to determine whether the patient's intraoperative pain at the surgical
      site is less after a WALANT procedure compared to a traditional ALR procedure (axillary or
      trunk).
    

Detailed description: 
      Median nerve neurolysis at the carpal tunnel is one of the most performed procedures in the
      world. The use of loco-regional anesthesia (LRA) is common practice for this surgery,
      especially since the use of ultrasound guidance, which allows visualization of the nerves and
      control of the injection of anesthetic products, makes it a safe technique. The nerve blocks
      most commonly used in hand surgery are axillary blocks and truncal blocks. The choice between
      these two techniques, which are equivalent in terms of effectiveness and duration of
      anesthesia, depends in practice on the habits of each practitioner. As the use of a pneumatic
      tourniquet during the operation is systematic, the axillary block, by anaesthetizing the
      whole arm, avoids the discomfort described by some patients when using a tourniquet. For
      others, the discomfort is related to the sensation of a "dead arm" with a duration of
      anesthesia of several hours, which the truncular block makes it possible to avoid.

      Recently, an alternative to traditional LRA by local anesthesia without tourniquet and
      without sedation (WALANT procedure: Wide Awake Local Anesthesia with No Tourniquet) has been
      described. Several studies show the efficacy and safety of this procedure, which is already
      used in current practice.

      However, to date, there is no comparative study evaluating the effectiveness of the WALANT
      procedure compared to traditional hand surgery techniques for carpal tunnel, neither
      published nor in progress. This is the purpose of this study.

      The WALANT technique, performed under ultrasound, includes two punctures.

        -  The first is a puncture through a medial approach above the wrist and includes two
           injections. A first subcutaneous injection reproducing a bar above the wrist flexion
           line, and a second injection above the median nerve. The volumes injected vary from 8 to
           10 milliliters (ml).

        -  The second puncture is performed at the base of the palmar surface of the hand and
           consists of a 10 ml subcutaneous injection of the local anesthetic in order to take
           advantage of the vasoconstrictive effects of adrenaline, thus allowing the surgical
           procedure to be performed without a pneumatic tourniquet.
    

Intervention name(s): Experimental: WALANT procedure; Active Comparator: Axial ALR; Active Comparator: Truncal ALR
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): The WALANT technique, performed under ultrasound, includes two punctures.
The first is a puncture through a medial approach above the wrist and includes two injections. A first subcutaneous injection reproducing a bar above the wrist flexion line, and a second injection above the median nerve. The volumes injected vary from 8 to 10 milliliters (ml).
The second puncture is performed at the base of the palmar surface of the hand and consists of a 10 ml subcutaneous injection of the local anesthetic in order to take advantage of the vasoconstrictive effects of adrenaline, thus allowing the surgical procedure to be performed without a pneumatic tourniquet.; The anesthetic protocol in the axillary block consists of performing a puncture, using a needle (50 mm 22G with a short bevel), under the armpit at the level of the axillary hollow after skin disinfection. This puncture, performed under ultrasound, allows the injection of the local anesthetic around the median, radial, ulnar and musculocutaneous nerves. The volume injected per nerve can vary from 5 to 8 ml depending on the visual appreciation during the injection.; The anesthetic protocol in truncal block consists in injecting the local anesthetic around the median and ulnar nerves by a puncture performed at the elbow or forearm (depending on the practitioner's experience). The volumes injected remain the same and the puncture is also performed under ultrasound guidance. Additional local anesthesia is administered by injecting an additional 5 ml above the wrist flexion line to block the sensory territory of the musculocutaneous nerve.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Interventional, prospective, therapeutic, comparative, randomized controlled open-label, non-inferiority, single-center, national study.
Masking: None (Open Label)
Primary purpose: Prevention