{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:17:08Z","timestamp":1791901028665,"version":"4.3.4"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":61,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"DOI":"10.1186\/s13018-026-06974-2","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:36:17Z","timestamp":1779878177000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical impact of wide-awake local anesthesia no tourniquet (WALANT) in carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.1186","volume":"21","author":[{"given":"Chia-You","family":"Chou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Ting","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Sheng","family":"Chien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Jung","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"issue":"12","key":"6974_CR1","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1016\/S1474-4422(16)30231-9","volume":"15","author":"L Padua","year":"2016","unstructured":"Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273\u201384.","journal-title":"Lancet Neurol"},{"key":"6974_CR2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/1749-799X-6-17","volume":"6","author":"Q Shi","year":"2011","unstructured":"Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review. J Orthop Surg Res. 2011;6:17.","journal-title":"J Orthop Surg Res"},{"issue":"7","key":"6974_CR3","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1016\/j.clinph.2013.11.010","volume":"125","author":"JL Andreu","year":"2014","unstructured":"Andreu JL, Ly-Pen D, Mill\u00e1n I, de Blas G, S\u00e1nchez-Olaso A. Local injection versus surgery in carpal tunnel syndrome: neurophysiologic outcomes of a randomized clinical trial. Clin Neurophysiol. 2014;125(7):1479\u201384.","journal-title":"Clin Neurophysiol"},{"issue":"4","key":"6974_CR4","first-page":"346","volume":"36","author":"AE Bagatur","year":"2002","unstructured":"Bagatur AE. Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation. Acta Orthop Traumatol Turc. 2002;36(4):346\u201353.","journal-title":"Acta Orthop Traumatol Turc"},{"key":"6974_CR5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11051386","author":"S Pripotnev","year":"2022","unstructured":"Pripotnev S, Mackinnon SE. Revision of carpal tunnel surgery. J Clin Med. 2022. https:\/\/doi.org\/10.3390\/jcm11051386.","journal-title":"J Clin Med"},{"issue":"5","key":"6974_CR6","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/j.jhsa.2005.05.006","volume":"30","author":"D Lalonde","year":"2005","unstructured":"Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie project clinical phase. J Hand Surg Am. 2005;30(5):1061\u20137.","journal-title":"J Hand Surg Am"},{"issue":"9","key":"6974_CR7","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1177\/1753193417728427","volume":"42","author":"DH Lalonde","year":"2017","unstructured":"Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol. 2017;42(9):886\u201395.","journal-title":"J Hand Surg Eur Vol"},{"key":"6974_CR8","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.bjps.2024.10.027","volume":"99","author":"A Siu","year":"2024","unstructured":"Siu A, Wong RS, Ahmed Z, Talwar C, Nikkhah D. Patient satisfaction using wide-awake local anaesthesia no tourniquet (WALANT) in adults undergoing elective hand surgery: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2024;99:475\u201385.","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"5","key":"6974_CR9","doi-asserted-by":"publisher","first-page":"101778","DOI":"10.1016\/j.hansur.2024.101778","volume":"43","author":"H Zimmermann","year":"2024","unstructured":"Zimmermann H, Quemeneur C, Goetsch T, Le Sach\u00e9 F, Bloc S. Wide-awake local anesthesia no tourniquet in hand surgery: a systematic review and meta-analysis. Hand Surg Rehabil. 2024;43(5):101778.","journal-title":"Hand Surg Rehabil"},{"issue":"1","key":"6974_CR10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1530\/EOR-2024-0014","volume":"10","author":"LC Focsa","year":"2025","unstructured":"Focsa LC, Bouch\u00e9 PA, Apard T, Querel D, Rousseau MA, Descamps J. Network meta-analysis comparing WALANT, locoregional, local and general anesthesia techniques in carpal tunnel release. EFORT Open Rev. 2025;10(1):3\u201313.","journal-title":"EFORT Open Rev"},{"key":"6974_CR11","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.","journal-title":"BMJ"},{"key":"6974_CR12","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.","journal-title":"BMJ"},{"issue":"4","key":"6974_CR13","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1136\/ebmental-2019-300117","volume":"22","author":"S Balduzzi","year":"2019","unstructured":"Balduzzi S, R\u00fccker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. 2019;22(4):153\u201360.","journal-title":"Evid Based Ment Health"},{"key":"6974_CR14","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2288-14-135","volume":"14","author":"X Wan","year":"2014","unstructured":"Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med Res Methodol. 2014;14:135.","journal-title":"BMC Med Res Methodol"},{"key":"6974_CR15","unstructured":"Chandler J, Cumpston M, Li T, Page MJ, Welch V. Cochrane handbook for systematic reviews of interventions. Hoboken: Wiley. 2019;4(1002):14651858."},{"issue":"1","key":"6974_CR16","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4103\/ds.DS-D-22-00154","volume":"41","author":"S-C Shao","year":"2023","unstructured":"Shao S-C, Kuo L-T, Huang Y-T, Lai P-C, Chi C-C. Using grading of recommendations assessment, development, and evaluation (GRADE) to rate the certainty of evidence of study outcomes from systematic reviews: a quick tutorial. Dermatol Sin. 2023;41(1):3\u20137.","journal-title":"Dermatol Sin"},{"key":"6974_CR17","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jclinepi.2021.07.011","volume":"139","author":"R Brignardello-Petersen","year":"2021","unstructured":"Brignardello-Petersen R, Guyatt GH, Mustafa RA, Chu DK, Hultcrantz M, Sch\u00fcnemann HJ, et al. GRADE guidelines 33: Addressing imprecision in a network meta-analysis. J Clin Epidemiol. 2021;139:49\u201356.","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"6974_CR18","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/0266-7681(93)90103-M","volume":"18","author":"BD Braithwaite","year":"1993","unstructured":"Braithwaite BD, Robinson GJ, Burge PD. Haemostasis during carpal tunnel release under local anaesthesia: a controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br. 1993;18(2):184\u20136.","journal-title":"J Hand Surg Br"},{"key":"6974_CR19","doi-asserted-by":"publisher","first-page":"234","DOI":"10.2174\/1874325001004010234","volume":"4","author":"P Ralte","year":"2010","unstructured":"Ralte P, Selvan D, Morapudi S, Kumar G, Waseem M. Haemostasis in open carpal tunnel release: tourniquet vs local anaesthetic and adrenaline. Open Orthop J. 2010;4:234\u20136.","journal-title":"Open Orthop J"},{"issue":"8","key":"6974_CR20","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1177\/1753193418778999","volume":"43","author":"HJ Iqbal","year":"2018","unstructured":"Iqbal HJ, Doorgakant A, Rehmatullah NNT, Ramavath AL, Pidikiti P, Lipscombe S. Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial. J Hand Surg Eur Vol. 2018;43(8):808\u201312.","journal-title":"J Hand Surg Eur Vol"},{"issue":"6","key":"6974_CR21","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1177\/1558944719836237","volume":"15","author":"GG Via","year":"2020","unstructured":"Via GG, Esterle AR, Awan HM, Jain SA, Goyal KS. Comparison of local-only anesthesia versus sedation in patients undergoing staged bilateral carpal tunnel release: a randomized trial. Hand (N Y). 2020;15(6):785\u201392.","journal-title":"Hand (N Y)"},{"issue":"6","key":"6974_CR22","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1590\/1516-3180.2020.0583.r2.0904221","volume":"139","author":"A Okamura","year":"2021","unstructured":"Okamura A, Moraes VY, Fernandes M, Raduan-Neto J, Belloti JC. WALANT versus intravenous regional anesthesia for carpal tunnel syndrome: a randomized clinical trial. Sao Paulo Med J. 2021;139(6):576\u20138.","journal-title":"Sao Paulo Med J"},{"issue":"4","key":"6974_CR23","first-page":"101229","volume":"42","author":"S Bloc","year":"2023","unstructured":"Bloc S, Squara P, Quemeneur C, Doirado M, Thomsen L, Merzoug M, et al. Wide awake local anesthesia no tourniquet (WALANT) technique improves the efficiency of distal nerve blocks for carpal tunnel release. Anaesth Crit Care Pain Med. 2023;42(4):101229.","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"12","key":"6974_CR24","doi-asserted-by":"publisher","first-page":"1529.e1","DOI":"10.1016\/j.jhsa.2025.02.001","volume":"50","author":"I Rell\u00e1n","year":"2025","unstructured":"Rell\u00e1n I, Molho NM, Donndorff AG, Gallucci GL, Ayerza MA, Boretto JG. Intraoperative pain during carpal tunnel release performed by experienced surgeons: a prospective randomized trial comparing WALANT with local anesthesia and tourniquet. J Hand Surg Am. 2025;50(12):1529.e1-.e6.","journal-title":"J Hand Surg Am"},{"key":"6974_CR25","doi-asserted-by":"crossref","unstructured":"Virtos M, Chassery C, Marty P, Basset B, Casalprim J, Vuillaume C, et al. Wide awake local anesthesia no tourniquet (WALANT) versus ultrasound-guided axillary block in carpal tunnel release: a non-inferiority randomized controlled trial. Reg Anesth Pain Med. 2025.","DOI":"10.1136\/rapm-2025-107152"},{"issue":"1","key":"6974_CR26","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1046\/j.1365-2044.2000.01128.x","volume":"55","author":"JP Estebe","year":"2000","unstructured":"Estebe JP, Le Naoures A, Chemaly L, Ecoffey C. Tourniquet pain in a volunteer study: effect of changes in cuff width and pressure. Anaesthesia. 2000;55(1):21\u20136.","journal-title":"Anaesthesia"},{"issue":"6","key":"6974_CR27","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1097\/EJA.0b013e328346d5a9","volume":"28","author":"JP Estebe","year":"2011","unstructured":"Estebe JP, Davies JM, Richebe P. The pneumatic tourniquet: mechanical, ischaemia-reperfusion and systemic effects. Eur J Anaesthesiol. 2011;28(6):404\u201311.","journal-title":"Eur J Anaesthesiol"},{"issue":"6","key":"6974_CR28","doi-asserted-by":"publisher","first-page":"554.e1","DOI":"10.1016\/j.jhsa.2019.10.035","volume":"45","author":"BS Shulman","year":"2020","unstructured":"Shulman BS, Rettig M, Yang SS, Sapienza A, Bosco J, Paksima N. Tourniquet use for short hand surgery procedures done under local anesthesia without epinephrine. J Hand Surg Am. 2020;45(6):554.e1-.e6.","journal-title":"J Hand Surg Am"},{"issue":"7","key":"6974_CR29","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/j.jhsa.2022.03.009","volume":"47","author":"DJ Randall","year":"2022","unstructured":"Randall DJ, Zhang Y, Li H, Hubbard JC, Kazmers NH. Establishing the minimal clinically important difference and substantial clinical benefit for the pain visual analog scale in a postoperative hand surgery population. J Hand Surg Am. 2022;47(7):645\u201353.","journal-title":"J Hand Surg Am"},{"issue":"1","key":"6974_CR30","doi-asserted-by":"publisher","first-page":"240","DOI":"10.3171\/2008.2.17395","volume":"114","author":"A Nabhan","year":"2011","unstructured":"Nabhan A, Steudel WI, Dedeman L, Al-Khayat J, Ishak B. Subcutaneous local anesthesia versus intravenous regional anesthesia for endoscopic carpal tunnel release: a randomized controlled trial. J Neurosurg. 2011;114(1):240\u20134.","journal-title":"J Neurosurg"},{"issue":"5","key":"6974_CR31","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1177\/1753193412453664","volume":"38","author":"AM S\u00f8rensen","year":"2013","unstructured":"S\u00f8rensen AM, Dalsgaard J, Hansen TB. Local anaesthesia versus intravenous regional anaesthesia in endoscopic carpal tunnel release: a randomized controlled trial. J Hand Surg Eur Vol. 2013;38(5):481\u20134.","journal-title":"J Hand Surg Eur Vol"},{"issue":"1","key":"6974_CR32","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1177\/1753193412442137","volume":"38","author":"JK Kim","year":"2013","unstructured":"Kim JK, Jeon SH. Minimal clinically important differences in the Carpal Tunnel Questionnaire after carpal tunnel release. J Hand Surg Eur Vol. 2013;38(1):75\u20139.","journal-title":"J Hand Surg Eur Vol"},{"key":"6974_CR33","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/1471-2474-7-78","volume":"7","author":"JC Leite","year":"2006","unstructured":"Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the boston carpal tunnel questionnaire. BMC Musculoskelet Disord. 2006;7:78.","journal-title":"BMC Musculoskelet Disord"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-026-06974-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-026-06974-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-026-06974-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T22:57:08Z","timestamp":1785106628000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13018-026-06974-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6974"],"URL":"https:\/\/doi.org\/10.1186\/s13018-026-06974-2","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]},"assertion":[{"value":"6 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable. This study is a systematic review and meta-analysis of previously published studies and did not involve direct interaction with human participants.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"448"}}