Carpal Tunnel SyndromeWALANT vs LA-TNCT07617064
WALANT Versus Local Anesthesia With Tourniquet for Carpal Tunnel Decompression
A study testing WALANT technique for carpal tunnel decompression and Local anesthesia with tourniquet for carpal tunnel decompression in people with Carpal Tunnel Syndrome, run by Misr University for Science and Technology at 2 sites in Egypt.
Trial 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… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Carpal Tunnel Syndrome
- What is being tested?
- WALANT technique for carpal tunnel decompression and Local anesthesia with tourniquet for carpal tunnel decompression
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 100 participants
- Where
- 2 sitesEgypt
- Study dates
- 1 Sep 2024to 15 Dec 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
2 sites in 1 country.
Egypt2 sites
Al-Azhar University Hospital (Neurosurgery Department)
Cairo
Misr University for Science and Technology Hospital (Orthopedic Surgery Department)
Giza
About this study
Official title: Intraoperative Pain During Carpal Tunnel Release: Wide-Awake Local Anesthesia No Tourniquet Versus Local Anesthesia and Tourniquet - A Randomized Controlled Trial
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.
Read the detailed description
Carpal tunnel decompression (CTD) is one of the most frequently performed hand procedures, and the optimal anesthetic technique remains debated. Traditionally, CTD has been performed under local anesthesia with a pneumatic tourniquet (LA-T), regional block, or general anesthesia; these approaches may cause tourniquet pain, require sedation, and increase resource use. Wide-awake local anesthesia no tourniquet (WALANT), using lidocaine with epinephrine infiltrated directly into the operative field, avoids the tourniquet and sedation while allowing intraoperative assessment of hand function. We conducted a multicenter, prospective, double-blinded randomized controlled trial comparing WALANT to LA-T for open CTD at two academic tertiary centers (an orthopedic surgery department in Giza and a neurosurgery department in Cairo) between December 2024 and December 2025. Adults with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS), ASA I-II, and eligible for surgical treatment were randomized 1:1 to WALANT (lidocaine with epinephrine, no tourniquet) or LA-T (lidocaine only with tourniquet). The primary outcome was overall intraoperative pain scored on a visual analog scale (VAS, 0-10). Secondary outcomes were pain during anesthetic infiltration, tourniquet pain (LA-T only), operative time, global patient satisfaction with the operating room experience, and intraoperative complications. Blinded assessors collected outcome data using standardized questionnaires immediately after surgery. A total of 100 patients were randomized (50 per group). The study adhered to the Declaration of Helsinki and CONSORT 2025 guidelines and received prior institutional ethics committee approval.
- Conditions
- Carpal Tunnel Syndrome
- Being tested
- WALANT technique for carpal tunnel decompression, Local anesthesia with tourniquet for carpal tunnel decompression
- Keywords
- Carpal tunnel release, Wide-awake local anesthesia no tourniquet, WALANT, Local anesthesia with tourniquet, Hand surgery, Intraoperative pain, Patient satisfaction
- Medical subject headings
- Carpal Tunnel Syndrome, Patient Satisfaction
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
WALANT technique for carpal tunnel decompressionProcedure or surgery
"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."
Local anesthesia with tourniquet for carpal tunnel decompressionProcedure or surgery
"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."
| Study group | Role | What they receive |
|---|---|---|
| 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." Receives: 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." Receives: Procedure: Local anesthesia with tourniquet for carpal tunnel decompression |
What is being measured
The primary outcome is the main question the study is designed to answer.
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."
Measured: Intraoperative.
Secondary outcomes (5)
Infiltration Pain (VAS)
"Pain at the time of local anesthetic infiltration, scored on a VAS 0-10."
Measured: Perioperative " During local anesthetic injection, assessed immediately after infiltration."
Tourniquet Pain (VAS) - LA-T Group Only
"Tourniquet-specific pain in the LA-T group, scored on VAS 0-10, recorded separately from overall intraoperative pain."
Measured: Perioperative " During tourniquet inflation, assessed after the primary intraoperative pain rating."
Operative Time
"Operative time in minutes, recorded from incision to completion of skin closure."
Measured: Intraoperative (from first skin incision to final skin closure).
Patient Satisfaction With Operating Room Experience
"Global patient satisfaction with the operating room experience, assessed using a numeric rating scale from 0 (not satisfied) to 10 (fully satisfied)."
Measured: Day 1 Postoperative
Intraoperative Complications
"Any deviation from the normal operative course, including bleeding requiring intervention, nerve injury, or other intraoperative adverse events, captured on the standardized operative record and postoperative questionnaire."
Measured: Baseline up to 30 days postoperatively.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Jun 2026
- Study start1 Sep 2024
- Primary completion13 Dec 2025
- Study completion15 Dec 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Carpal Tunnel SyndromeStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 100 participants (actual)
Sponsor and investigators
- Lead sponsor
- Misr University for Science and Technology
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mohamed Ahmed Tolba Abdelsalam, Misr University for Science and Technology
- Investigators
- Mohammed S.K. Hamza, MD, PhD, Principal investigator, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07617064
- Sponsor's protocol ID
- WALANTvsLAT-CTD-RCT-01
- Acronym
- WALANT vs LA-T
- Status last verified
- May 2026
- First submitted
- 17 May 2026
- Last updated
- 1 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: "There is no plan to share individual participant data (IPD) from this study outside the study team."
Study at a glance
From the registry record, last updated by the sponsor on 1 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Intraoperative Pain During Carpal Tunnel Release: Wide-Awake Local Anesthesia No Tourniquet Versus Local Anesthesia and Tourniquet - A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07617064
- Acronym / sponsor ID
- WALANT vs LA-T / WALANTvsLAT-CTD-RCT-01
- 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
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 100 participants (actual)
- Lead sponsor
- Misr University for Science and TechnologyUniversity, hospital or other
- Study start
- 1 Sep 2024 (actual)
- Primary completion
- 13 Dec 2025 (actual)
- Study completion
- 15 Dec 2025 (actual)
- First posted
- 1 Jun 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
Carpal tunnel decompression (CTD) is one of the most frequently performed hand procedures, and the optimal anesthetic technique remains debated. Traditionally, CTD has been performed under local anesthesia with a pneumatic tourniquet (LA-T), regional block, or general anesthesia; these approaches may cause tourniquet pain, require sedation, and increase resource use. Wide-awake local anesthesia no tourniquet (WALANT), using lidocaine with epinephrine infiltrated directly into the operative field, avoids the tourniquet and sedation while allowing intraoperative assessment of hand function. We conducted a multicenter, prospective, double-blinded randomized controlled trial comparing WALANT to LA-T for open CTD at two academic tertiary centers (an orthopedic surgery department in Giza and a neurosurgery department in Cairo) between December 2024 and December 2025. Adults with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS), ASA I-II, and eligible for surgical treatment were randomized 1:1 to WALANT (lidocaine with epinephrine, no tourniquet) or LA-T (lidocaine only with tourniquet). The primary outcome was overall intraoperative pain scored on a visual analog scale (VAS, 0-10). Secondary outcomes were pain during anesthetic infiltration, tourniquet pain (LA-T only), operative time, global patient satisfaction with the operating room experience, and intraoperative complications. Blinded assessors collected outcome data using standardized questionnaires immediately after surgery. A total of 100 patients were randomized (50 per group). The study adhered to the Declaration of Helsinki and CONSORT 2025 guidelines and received prior institutional ethics committee approval.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| WALANT (Wide-Awake Local Anesthesia No Tourniquet) | Experimental | Procedure: WALANT technique for carpal tunnel decompression"Patients received wide-awake local anesthesia with epinephrine infiltration in the operative field, without arm tourniquet or routine sedation, for open carpal tunnel decompression." |
| Local Anesthesia With Tourniquet (LA-T) | Active comparator | Procedure: Local anesthesia with tourniquet for carpal tunnel decompression"Patients received buffered lidocaine without epinephrine and an upper-arm pneumatic tourniquet for open carpal tunnel decompression." |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- 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.
Key exclusion criteria (6 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| WALANT technique for carpal tunnel decompression"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." | Procedure or surgery | WALANT (Wide-Awake Local Anesthesia No Tourniquet) |
| Local anesthesia with tourniquet for carpal tunnel decompression"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." | Procedure or surgery | Local Anesthesia With Tourniquet (LA-T) |
Primary outcome
Intraoperative Pain (VAS)
Time frame: Intraoperative.
"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."
5 secondary outcomes
Infiltration Pain (VAS)
Time frame: Perioperative " During local anesthetic injection, assessed immediately after infiltration."
Tourniquet Pain (VAS) - LA-T Group Only
Time frame: Perioperative " During tourniquet inflation, assessed after the primary intraoperative pain rating."
Operative Time
Time frame: Intraoperative (from first skin incision to final skin closure).
Patient Satisfaction With Operating Room Experience
Time frame: Day 1 Postoperative
Intraoperative Complications
Time frame: Baseline up to 30 days postoperatively.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Jun 2026.
- Individual participant dataSharing planned: No. "There is no plan to share individual participant data (IPD) from this study outside the study team."
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mohammed S.K. Hamza, MD, PhD principal investigator
Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing WALANT technique for carpal tunnel decompression and Local anesthesia with tourniquet for carpal tunnel decompression in people with Carpal Tunnel Syndrome, run by Misr University for Science and Technology at 2 sites in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 1 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Intraoperative Pain (VAS) (time frame: Intraoperative.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Jun 2026.