What Is the Infection Rate of Carpal Tunnel Syndrome and Trigger Finger Release Performed Under Wide-Awake Anesthesia?

Hand (N Y). 2023 Mar;18(2):198-202. doi: 10.1177/1558944721994262. Epub 2021 Mar 31.


Background: High infection rates have been reported in hand procedures using the wide-awake local anesthesia no tourniquet (WALANT) method, causing some to question the validity of this approach. However, little evidence exists surrounding the direct use of WALANT compared with monitored anesthetic care (MAC). This study was conducted to directly compare the postoperative infection rates of carpal tunnel syndrome (CTS) and trigger finger (TF) release surgeries performed under WALANT and MAC.

Methods: A retrospective study comparing postoperative infection rates between patients undergoing CTS and TR releases was conducted. Our primary outcome measure was postoperative infection. Our secondary outcome was postoperative complications. Comparative statistics were used to compare means of infection between the groups.

Results: A total of 526 patients underwent CTS release (255 with WALANT and 271 with MAC), and 129 patients underwent TF release (64 with WALANT and 65 with MAC). Patients undergoing WALANT and MAC were statistically comparable in terms of sex, smoking status, diabetes, and American Society of Anesthesiologists physical status classification. In patients undergoing CTS release, there were no infections with WALANT and 6 infections (2.2%) with MAC. In patients undergoing TF release, there were no infections in either group. There were similar rates of complications in patients undergoing WALANT and MAC for CTS and TF releases.

Conclusion: There was no increased risk of infection with WALANT compared with MAC in CTS or TR surgeries. These surgeries can be safely conducted with lidocaine and epinephrine without a concern for increased risk of infections or complications.

Keywords: WALANT; hand surgery; local anesthesia; tourniquet; wide-awake.

MeSH terms

  • Anesthesia, Local / methods
  • Anesthetics, Local
  • Carpal Tunnel Syndrome* / surgery
  • Humans
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Trigger Finger Disorder* / surgery


  • Anesthetics, Local