***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Wide-awake , local anesthesia , no tourniquet ( WALANT ) h and surgery was developed to improve access to h and surgery care while optimizing medical re sources . H and surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System ( MHS ) and provide a safe alternative to performing similar procedures in the operating room . METHODS A prospect i ve cohort study was performed on the first 100 consecutive clinic-based WALANT h and surgery procedures performed at a military medical center from January 2014 to September 2015 by a single h and surgeon .  Cost savings analysis was performed by using the  Medical Expense and Performance Reporting System , the st and ard cost accounting system for the MHS , to compare procedures performed in the clinic versus the operating room during the study period . A study specific question naire was obtained for 66 procedures to evaluate the patient 's experience . RESULTS For carpal tunnel release ( n = 34 ) and A1 pulley release ( n = 33 ) , there were 85 % and 70 % cost savings by having the procedures performed in clinic under WALANT compared with the main operating room , respectively . During the study period , carpal tunnel release , A1 pulley release , and de Quervain release performed in the clinic instead of the operating room amounted to $ 393,100 in cost savings for the MHS . There were no adverse events during the WALANT procedure . CONCLUSIONS A clinic-based WALANT h and surgery program at a military medical center results in considerable cost savings for the MHS . TYPE OF STUDY /LEVEL OF EVIDENCE Economic/Decision Analysis IV Background The purpose of this study was to provide prospect i ve independently analyzed evidence on how patients feel about a carpal tunnel release ( CTR ) performed under local anesthesia only ( no sedation or tourniquet ) versus with  local anesthesia , intravenous ( IV ) sedation , and a tourniquet . Methods This prospect i ve cohort study compared 100 consecutive CTRs done with only lidocaine and epinephrine in Saint John , New Brunswick to 100 consecutive CTRs done with IV sedation in Davenport , Iowa . Patient perspectives on the anesthesia were captured in a blinded question naire 1 week postoperatively . Results For subsequent surgery , 93 % of wide awake patients would choose local anesthesia only and 93 % of se date d patients would choose sedation . Wide awake patients spent less time at the hospital ( M = 2.6 h ) than se date d patients ( M = 4.0 h ; p < .001 ) . Preoperative blood work , electrocardiograms , and /or chest radiographs were done for 3 % of wide awake patients and 48 % of se date d patients ( p < 0.001 ) . Preoperative anxiety levels for wide awake patients were lower than for se date d patients ( p = 0.007 ) ; postoperative anxiety was similar . There were no anesthesia complications in either group . Narcotics were used by 5 % of unse date d patients and 67 % of se date d patients ( p < 0.001 ) . Adequate pain control was reported by 89 % and 90 % of patients , respectively . Conclusions The majority of patients from both cohorts liked whichever method of anesthesia they received and would choose it again . However , se date d patients spent more time at the hospital , required more preoperative testing , and reported greater preoperative anxiety Purpose : Minor h and surgeries can be done under field sterility in procedure rooms . Surgeons are still sceptical about the usage of wide awake local anaesthesia no tourniquet ( WALANT ) technique . They perceive that patients can tolerate tourniquet for a brief period while they perform minor surgeries under local anaesthesia ( LA ) . We compared the perceived comfort experienced by patients during minor h and surgeries with WALANT and LA/tourniquet .  We investigated the difference in preoperative preparation time , operating time and blood loss between the two groups . Methods : Between July and October 2016 , a total of 72 patients were diagnosed with carpal tunnel syndrome , trigger finger or ganglion , at the University Malaya Medical Centre . Forty patients consented to participate in this study and were r and omized into WALANT and LA/tourniquet groups . Anaesthesia was administered accordingly and tourniquet was applied . The time taken for preoperative preparation and surgery was recorded . Each surgeon estimated the blood loss . The perceived comfort level of each patient was quantified using a visual analogue score ( VAS ) . Data were analysed using SPSS . Results : The mean VAS for the WALANT group was 2.33 ± 1.94 , whereas it was 4.72 ± 3.05 for the LA/tourniquet group , and the difference was statistically significant ( p < 0.05 ) . The mean time for preoperative preparation  in WALANT group was 19.17 ± 12.61 min and LA/tourniquet group was 7.05 ± 3.44 min . The difference between these groups was statistically significant ( p < 0.01 ) . There was no significant difference in operating time and blood loss . Conclusion : WALANT technique was associated with better patient comfort . Tourniquet was the main reason for discomfort during surgeries . WALANT is an alternative in minor h and surgeries for a bloodless surgical field without the discomfort of tourniquet application Background : We prospect ively evaluated opioid consumption postoperatively following trigger finger release ( TFR ) and open carpal tunnel release ( CTR ) , and hypothesized that cases performed wide awake with local anesthesia and no tourniquet ( WALANT ) would result in increased opioid consumption compared with cases performed under monitored anesthesia care ( MAC ) . Methods : Postoperative opioid consumption following CTR  and  TFR was prospect ively collected over 6 months . The primary end points of the study were : ( 1 ) total opioid consumption ; and ( 2 ) the number of days an opioid was used for both groups . Results : Mean opioid use and number of days the opioid was used for all MAC cases were 3.95 pills and 1.8 days , respectively . The results for WALANT were 3.85 pills and 1.6 days . Conclusions : These results suggest that effective pain control postoperatively may be independent of anesthesia type for soft tissue procedures of the h and . Specifically , average opioid consumption and days of utilization were similar in both the MAC and WALANT groups . Average postoperative opioid consumption was approximately only 4 opioid pills . Consideration should be given to prescribing fewer opioids for surgeries such as CTR and TFR BACKGROUND Most minor h and operations can be performed with local anesthesia and tourniquet . Some literature supports this concept based on the believe that the " patient can tolerate it " . Nowadays , the wide-awake technique with epinephrine- contained lidocaine is safe . This technique does not need a tourniquet because epinephrine provides local vasoconstriction . OBJECTIVE The present study was design ed to compare patients ' comfort and effectiveness of local anesthesia as well as bleeding at the surgical site between wide-awake anesthesia and local lidocaine with tourniquet application . MATERIAL AND METHOD Prospect i ve Clinical Trial was performed in 60 patients who received outpatient surgery for common h and problems at Maharaj Nakorn Chiang Mai Hospital . With r and omization , 30 patients were in wide-awake group , who received adrenaline-contained lidocaine as a local anesthetic agent , with tourniquet wrapping but with no pressure applied ( group 1 ) . The other 30 patients were in the conventional group that received lidocaine ( no adrenaline ) and a 250-mmHg tourniquet application ( group 2 ) . Operations were performed with st and ard methods . Visual analog scores , surgical field bleeding , amount of bleeding , any complications within 4 weeks were recorded . RESULTS There are no significant differences between the two groups in terms of patient profiles ( sex , age and diseases ) , injected site pain and surgeon 's opinion of surgical site bleeding . Tourniquet 's pain and the amount of blood loss in the conventional group were significantly higher than the wide-awake group . CONCLUSION Wide-awake technique ( no tourniquet applied ) offers better comfort for patients and less total blood loss while providing effective anesthesia and patient safety as with the conventional technique We conducted a prospect i ve r and omized controlled trial to investigate carpal tunnel decompression under local anaesthesia . Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an arm tourniquet and 36 without tourniquet but with a local anaesthetic mixture containing adrenaline . Patients who underwent  carpal tunnel decompression  using a tourniquet experienced a significantly greater degree of pain when compared with those who did not have a tourniquet .  Pain and h and function improved to a similar degree in both groups . We conclude that carpal tunnel decompression performed with a tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a tourniquet . Level of evidence : 
    Output:
    
All study design s defined by the Oxford Centre for Evidence -Based Medicine will be included in the search . "