Comparison of Ultrasound-Guided and Landmark-Based WALANT Techniques in Carpal Tunnel Surgery: A Cadaveric Evaluation with Radiological Imaging

Authors : Abdullah Örs, Özgür Çakır, Can Aksu, Hadi Ufuk Yörükoğlu, Volkan Alparslan, Serdar Demiröz, Tuncay Çolak, Alparslan Kuş
Pages : 167-170
Doi:10.30934/kusbed.1733825
View : 46 | Download : 43
Publication Date : 2025-09-30
Article Type : Research Paper
Abstract :Objective: The WALANT (Wide Awake Local Anesthesia No Tourniquet) technique has gained popularity in hand surgery due to its simplicity, cost-effectiveness, and elimination of tourniquet-related discomfort. Despite its widespread use, the anatomical accuracy of anesthetic spread between ultrasound-guided (USG) and landmark-based (blind) WALANT injections remains underexplored. To compare the anatomical distribution and perineural coverage of anesthetic solution delivered via ultrasound-guided versus blind WALANT techniques using computed tomography (CT) and magnetic resonance imaging (MRI) in a cadaveric model. Methods: WALANT injections were applied to the upper limbs of a formalin-fixed female cadaver. The right upper limb received USG-guided injection, while the left received a blind injection based on surface landmarks. A radiopaque contrast solution was used, and imaging was performed via 640-slice CT and 1.5T MRI. Distribution patterns were evaluated in axial, coronal, and sagittal planes. Results: USG-guided injection demonstrated a more compact, deeper, and anatomically precise distribution, particularly with pronounced perineural spread around the median nerve within the carpal tunnel. The blind technique showed broader but less focused spread, extending to superficial planes with less perineural accumulation. Conclusion: Ultrasound-guided WALANT injection provides superior anatomical targeting and perineural anesthetic coverage compared to the landmark-based technique. Routine use of ultrasound guidance in WALANT procedures is recommended to enhance effectiveness and reduce anatomical variation-related complications.
Keywords : Karpal tünel, Periferik sinir bloğu, Nervus medianus

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