Cost analysis of carpal tunnel release with local anesthesia vs sedation. A survey of the Argentinian Association of Hand Surgery.

Abstract

Purpose: To compare the costs of carpal tunnel release (CTR) performed in a minor procedure room using wide awake local anesthesia no tourniquet (WALANT), local anesthesia with a tourniquet (AL-T) and CTR in a conventional operating room (OR) with sedation. Additionally, we aimed to assess the anesthetic preferences of the Argentine Association of Hand and Upper Limb Reconstructive Surgery (AACM) members regarding CTR.

Material and methods: This cross-sectional, single-center study involved analyzing specific hospital costs associated with each anesthesia technique in both surgical settings. A report was obtained from the OR chief of our institution. Additionally, an anonymous survey was conducted among certified and main AACM members, gathering data on: (1) practice location, (2) preferred anesthesia type for CTR and reasons for not using WALANT/AL-T regularly, (3) years of practice, (4) preferred CTR surgical technique, and (5) willingness to change anesthesia preference if offered differential fees.

Results: Performing CTR with WALANT and AL-T in a procedure room resulted in cost savings of 64 % and 65 %, respectively, compared to sedation in a conventional OR. The average duration for CTR, including cleaning and turnover time, was 34 min (±3) for WALANT, 33 min (±4) for AL-T, and 55 min (±8) for sedation in a conventional operating room.Out of 226 AACM members, 95 (42 %) responded to the survey. Among them, 42 % practiced in Buenos Aires (CABA), and only 35 % preferred using local anesthesia for CTR (16 % WALANT, 19 % AL-T). Nearly half (49 %) had over 16 years of experience. All respondents favored open or mini-approach techniques for CTR. Those who did not use WALANT or AL-T cited discomfort with patient interaction and perceived lack of benefits as reasons. However, 31 % indicated they would change their anesthesia preference if offered differential fees.

Conclusions: CTR with WALANT or AL-T in a procedure room reduces costs by over 65 % compared to sedation in a conventional OR. Despite cost benefits, sedation remains the predominant practice in Argentina, hindered by a lack of consensus and institutional incentives.