Comparison of WALANT and general anaesthesia for trapeziectomy and abductor pollicis longus hammock ligamentoplasty.

Background: Trapeziectomy and abductor pollicis longus hammock ligamentoplasty may be performed in the surgical management of trapeziometacarpal joint osteoarthritis (TMC OA). Several anaesthesia techniques are available for TMC joint surgery, including wide-awake local anaesthesia no tourniquet (WALANT), regional anaesthesia, and general anaesthesia (GA). The aim of this study was to compare the clinical outcomes of trapeziectomy and abductor pollicis longus hammock ligamentoplasty performed under WALANT versus GA. Methods: This retrospective study included 22 patients who underwent surgery for TMC OA between 2017 and 2019. Patients' pre- and post-operative pain intensity, grip and pinch strength, and functional scores were compared. Pain intensity was assessed 1 h after surgery, while overall outcome measures were evaluated one year post-operatively. Results: The results showed that patients who underwent WALANT had significantly lower pain intensity 1 h postoperatively compared to those who received GA. Both groups experienced a reduction in pain, improvement in grip strength, and functional scores after at one year, with no significant differences between them. No significant differences were found between the GA and WALANT groups in terms of postoperative VAS scores, grip strength, and functional scores. Conclusions: We recommend WALANT for trapeziectomy and APL hammock ligamentoplasty due to its effectiveness in reducing early post-operative pain and achieving functional outcomes comparable to those of GA.