TOPLINE:

The wide-awake local anesthesia no tourniquet technique achieved a 100% rate of success in patients undergoing endoscopic carpal tunnel release compared with a rate of success below 90% with ultrasound-guided axillary block. Patient autonomy was improved in the wide-awake local anesthesia no tourniquet group, the researchers reported.

METHODOLOGY:

• Researchers conducted a prospective randomized, noninferiority trial in France (May 2024-January 2025) to compare the two anesthesia strategies in 129 adult patients (mean age, 63.1 years; 58% male) undergoing endoscopic carpal tunnel release.
• Patients were randomly assigned to receive ultrasound-guided axillary block, achieved with 30 mL of lidocaine (n = 65), or wide-awake local anesthesia no tourniquet, under which they received 20 mL of lidocaine with epinephrine, 17 mL of saline, and 3 mL of sodium bicarbonate (n = 64).
• If patients experienced discomfort during surgery, a blinded physician could administer additional anesthesia using sedatives, analgesics, or additional local anesthetics or general anesthesia.
• The primary outcome was the success rate in providing surgical anesthesia without additional supplementation, with noninferiority of wide-awake local anesthesia no tourniquet established if the lower limit of the 90% two-sided CI for the difference between the two treatments exceeded the noninferiority margin of delta = -0.1.
• Secondary outcomes included duration of surgery, time to incision, length of hospital stay, and patient satisfaction.

TAKEAWAY:

• The success rate in providing surgical anesthesia without additional interventions was 100% in the wide-awake local anesthesia no tourniquet group compared with 89% in the ultrasound-guided axillary block group.
• Noninferiority of wide-awake local anesthesia no tourniquet was confirmed as per the predetermined criteria for noninferiority (P < .05).
• Patient autonomy, particularly the ability to dress independently, was significantly higher in the wide-awake local anesthesia no tourniquet group than in the ultrasound-guided axillary block group (92% vs 58%; P < .001), and patient satisfaction regarding discomfort was improved in the former group (P < .05).
• No significant differences were observed in terms of length of stay, intraoperative bleeding, or postoperative pain between the two groups. Adverse events were minor and similar in both groups.

IN PRACTICE:

The wide-awake local anesthesia no tourniquet technique “should enhance workflow and thus improve efficiency of an ambulatory surgical facility. Further studies should focus on patient satisfaction and clinical pathways,” the researchers of the study reported.

SOURCE:

The study was led by Marie Virtos, Department of Anesthesiology, Clinique Medipole Garonne, Toulouse, France. It was published online on November 13, 2025, in Regional Anesthesia & Pain Medicine.

LIMITATIONS:

The definition of block success may have led to a lower-than-expected rate of success in the group of patients who received ultrasound-guided axillary block because additional anesthesia could be administered for various reasons. This single-center study may not be generalizable to other settings. The exclusion of anxious patients could affect the study’s external validity.

DISCLOSURES:

No specific grants were declared for this research. No competing interests were declared by the authors of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.