Title : WALANT for cubital tunnel syndrome: A systematic review and meta-analysis of safety and clinical outcomes
Abstract:
Cubital tunnel surgery is performed under general or regional anaesthesia.Wide-Awake Local Anaesthesia No Tourniquet (WALANT) may reduce anaesthetic dependency, postoperative pain and resource use while permitting active assessment of ulnar nerve stability. We evaluated clinical outcomes, anaesthetic feasibility and reported complications.
Methods:
Following PRISMA 2020 guidance (PROSPERO CRD420261407435), MEDLINE, Embase, Scopus and Google Scholar were searched from inception to June 2026.Comparative and uncontrolled studies of decompression, medial epicondylectomy or anterior transposition under awake local infiltration without routine tourniquet inflation were included. Meta-analysis was undertaken where sufficiently comparable data were available.
Results:
Twelve studies (535 participants; five comparative and seven uncontrolled) were included. Three comparative studies involving 111 participants showed no difference
in patient-reported disability between awake local and comparator anaesthesia (standardised mean difference 0.13, 95% confidence interval −0.23 to 0.50; I2=0%).
Revision or reoperation evidence was sparse and imprecise(risk ratio 0.36, 95% confidence interval 0.12 to 1.05; I2=46%). Individual studies reported lower early
postoperative pain and shorter perioperative pathways.Supplemental infiltration was sometimes required, and seven of 40 intended-WALANT anterior transpositions changed
to general anaesthesia. Reported adverse events were uncommon but inconsistently ascertained.
Conclusion:
Awake local anaesthesia without routine tourniquet inflation appears feasible for selected patients and provides similar medium-term function to general or
regional anaesthesia, with possible early pain and efficiency advantages. Current evidence does not establish superior neurological recovery, lower revision risk or
definitive safety.Operative selection should remain independent of anaesthetic choice, with counselling and a rescue pathway
