Hand surgery under local anesthesia only has been utilized more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release (CTR) performed under local anesthesia (WALANT) only to those performed under intravenous sedation (MAC).
A retrospective comparison of intra-operative (OR) surgical time and post-operative (PACU) time for consecutive CTR procedures performed under both MAC and WALANT was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost analysis was performed via standardized anesthesia billing based on base units, time, and conversion rates.
There were no significant differences between the two groups in terms of total OR time, 28 minutes in the MAC group versus 26 minutes in the WALANT group. PACU times were significantly longer in the MAC group (84 minutes) compared to the WALANT group (7 minutes). Depending on conversion rates used, a total of $139-$432 was saved in each case done with WALANT by not using anesthesia services. In addition, a range of $1,320-$1,613 was saved for the full episode of care including anesthesia costs, OR time, and PACU time for each patient undergoing WALANT CTR.
CTR surgery performed with the WALANT technique offers significant reduction in cost utilization of anesthesia and PACU resources.