<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04494100</url>
  </required_header>
  <id_info>
    <org_study_id>2020/02</org_study_id>
    <nct_id>NCT04494100</nct_id>
  </id_info>
  <brief_title>WALANT Technique (Wide Awake Local Anesthesia No Tourniquet) for Carpal Tunnel Release.</brief_title>
  <acronym>WALA</acronym>
  <official_title>WALANT Technique (Wide Awake Local Anesthesia No Tourniquet) in Association With Analgesic Troncular Blocks at the Wirst for Carpal Tunnel Release.</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>CMC Ambroise Paré</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>CMC Ambroise Paré</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The carpal tunnel release (CTR) is now performed almost exclusively under regional anesthesia&#xD;
      (RA) in France. RA requires the use of a pneumatic tourniquet to limit blood flow to the&#xD;
      operated extremity and create a bloodless surgical field for a clear visualization of the&#xD;
      anatomic structures by the surgeon.&#xD;
&#xD;
      Multiple approaches to block the brachial plexus can be considered. The most common technique&#xD;
      is the axillary block (BAX) that provides complete anesthesia for the patient's arm and&#xD;
      forearm. This technique offers anesthesia not only for the surgical area but also for the&#xD;
      root of the arm where the pneumatic tourniquet is placed. However this technique have limits:&#xD;
      the persistence of a motor block in the arm and the forearm that is not compatible with a&#xD;
      quick hospital discharge (short term ambulatory hospitalization) and the need for assistance&#xD;
      with dressing and eating after surgery. More distal anesthetic techniques are proposed such&#xD;
      as the troncular blocks (TRONC) that avoid motor block of the arm and offer an earlier&#xD;
      recovery and autonomy for the patient. However, they lead to a poor tolerance to the&#xD;
      tourniquet due to its application on a non-anesthetized area.The pain related to the pressure&#xD;
      of the tourniquet can occur within the first few minutes of its inflation, get worse over&#xD;
      time and persist for several minutes after its deflation. Therefore, TRONC procedure is less&#xD;
      often performed compared to the BAX for major surgeries but it remains appropriate for CTR.&#xD;
&#xD;
      The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique is widely used in Canada and&#xD;
      has been proposed for hand and wirst minor surgeries. WALANT uses a combination of a local&#xD;
      anesthetic (LA) and epinephrine to induce anesthesia and hemostasis in the area of the&#xD;
      surgical procedure in order to allow surgeries to be done without the use of tourniquet.&#xD;
      Epinephrine is a vasoconstrictor agent that reduces blood flow at surgical site. This&#xD;
      bloodless effect is visualized on the skin by a pale color. Thus, WALANT can provide a&#xD;
      chemical tourniquet and eliminate the pain from a traditional arm tourniquet. However, this&#xD;
      technique is performed with a short-acting LA and does not offer any postoperative analgesia.&#xD;
&#xD;
      The association of TRONC using long-acting LA with the WALANT technique could combine the&#xD;
      comfort of a surgery without tourniquet to a long-acting analgesia and thus could provide a&#xD;
      superior overall comfort.&#xD;
&#xD;
      The main objective of this prospective, multicentre, randomized, open-label, parallel-group&#xD;
      controlled trial is to evaluate the interest of WALANT technique on patient comfort during&#xD;
      CTR performed with TRONC, compared to the tourniquet.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      This is a multicenter, prospective, randomized, open-label study assessing the interest of&#xD;
      the association of the WALANT local infiltration technique with analgesic troncular blocks&#xD;
      (TRONC) at the wrist, for the endoscopic CTR.&#xD;
&#xD;
      This study compares two groups:&#xD;
&#xD;
        -  CONTROL group (usual technique) : TRONC (using a long-acting LA : Ropivacaine) +&#xD;
           Tourniquet&#xD;
&#xD;
        -  WALANT group (experimental technique) : TRONC (using a long-acting LA : Ropivacaine) +&#xD;
           WALANT ( using a short-term LA : Lidocaine + epinephrine)&#xD;
&#xD;
      RA procedures will be systematically performed under ultrasound guidance, 45 min befor&#xD;
      surgery. Before each procedure, a skin disinfection will be carried out using an alcoholic&#xD;
      iodine solution. The needle approach will be in-plane (IP) or out-of-plane (OOP). Efficiency&#xD;
      will be assessed before transfer to the operating room.&#xD;
&#xD;
        -  Troncular blocks (TRONC) Patients will be installed in supine position, the arm at 90°&#xD;
           of abduction and in external rotation. The probe will be positioned to have an axial&#xD;
           view of the nerves at the wrist. The initial identification of the median (nM) and ulnar&#xD;
           (nU) nerves will be systematically done before each TRONC. The nM will be located on the&#xD;
           anterior forearm. The nU will be visualized in contact with the ulnar artery in the&#xD;
           forearm. The operator will inject 3 to 7 mL of Ropivacaine 3.75 mg/ml per nerve. An&#xD;
           infiltration of 2 ml of Ropivacaine 3.75 mg/ml will be performed laterally above the&#xD;
           flexion fold of the wrist in order to block the branches of the lateral cutaneous nerve&#xD;
           of the forearm, the terminal sensory branch of the musculocutaneous nerve (nMC). A 22&#xD;
           Gauge x 50 mm needle will be used for TRONC.&#xD;
&#xD;
        -  WALANT infiltration (&quot;WALANT&quot; group) An infiltration of the subcutaneous area in front&#xD;
           of the transverse ligament will be performed between the thenar and hypothenar&#xD;
           eminences, from the flexion fold of the wrist over a length of 5 cm. The path of the nM&#xD;
           in the palm of the hand will be checked before each procedure. 3 to 7 ml of 1% lidocaine&#xD;
           (10 mg/ml) combined with 0.005 mg/ml epinephrine and 8.4% sodium bicarbonate (1 ml per&#xD;
           10 ml of lidocaine) will be injected. The addition of sodium bicarbonate will reduce the&#xD;
           pain due to lidocaine injection. A 24 Gauge x 50 mm needle will be used for WALANT.&#xD;
&#xD;
        -  Usage of pneumatic Tourniquet A pneumatic tourniquet will be placed at the root of the&#xD;
           arm in all patients. A cuff with size and shape adapted to the patient will be used. The&#xD;
           tourniquet will be inflated in all patients of &quot;CONTROL&quot; group, and if necessary,&#xD;
           corresponding to the failure of the WALANT technique, in patients of &quot;WALANT&quot; group. The&#xD;
           inflation pressure will be determined according to the patient's systolic blood pressure&#xD;
           (SBP). It will be inflated 75 to 100 mmHg above SBP&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">September 11, 2020</start_date>
  <completion_date type="Actual">July 5, 2021</completion_date>
  <primary_completion_date type="Actual">June 25, 2021</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Other</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Patient comfort during CTR</measure>
    <time_frame>4 hours</time_frame>
    <description>Pain score using a Visual Analogue Sclae (VAS) ranging from 0 to 10 (0= completely painless, 10= extremely painfull).</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Quality of the endoscopic surgical procedure</measure>
    <time_frame>4 hours</time_frame>
    <description>Numeric Rating Scale (NRS) for visualization during endoscopic surgery ranging from 0 to 5 ( 0=very poor conditions; 5=optimal conditions)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Troncular block success</measure>
    <time_frame>30 minutes</time_frame>
    <description>Sensory perception to pin-prick on the specific territories of the median, ulnar and radial nerves at 10, 20 and 30 minutes post injection using a 3-point rating: 0 = absence of block (sharp sensation to pinprick), 1 = analgesia (dull sensation to pinprick), 2 = anesthesia (loss of sensation to pinprick)The need for an additional block, an intraoperative surgical infiltration or a sedation will be noted.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>WALANT technique success</measure>
    <time_frame>30 minutes</time_frame>
    <description>Modification (or not) of the skin color near the injection area at 10, 20 and 30 minutes postinjection.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Hemostasis quality for the WALANT group</measure>
    <time_frame>4 hours</time_frame>
    <description>Usage (or not) of tourniquet.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Patient satisfaction</measure>
    <time_frame>4 hours</time_frame>
    <description>Patient satisfaction score collected in post-anesthesia care unit (PACU) using a Numeric Rating Scale (NRS-Satisfaction) ranging from 0 (very unsatisfied) to 10 (very satisfied).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Surgery duration</measure>
    <time_frame>4 hours</time_frame>
    <description>Time (in minutes) between the skin incision and the last suture.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Rate of complications</measure>
    <time_frame>20 days</time_frame>
    <description>Incidence of complications related to RA procedure</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">60</enrollment>
  <condition>Carpal Tunnel Release</condition>
  <arm_group>
    <arm_group_label>CONTROL</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Troncular blocks using a long-acting LA + Tourniquet</description>
  </arm_group>
  <arm_group>
    <arm_group_label>WALANT</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Troncular blocks using a long-acting LA + WALANT technique using a short-term LA with epinephrine a vasoconstrictor agent</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>TRONC</intervention_name>
    <description>injection of 3 to 7 mL of Ropivacaine 3.75 mg/ml per nerve (median and ulnar nerves) and infiltration of 2 ml of Ropivacaine 3.75 mg/ml laterally above the flexion fold of the wrist in order to block the branches of the lateral cutaneous nerve of the forearm, the terminal sensory branch of the musculocutaneous nerve.</description>
    <arm_group_label>CONTROL</arm_group_label>
    <arm_group_label>WALANT</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>WALANT</intervention_name>
    <description>infiltration with 3 to 7 ml of 1% lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine and 8.4% sodium bicarbonate in the subcutaneous area in front of the transverse ligament, between the thenar and hypothenar eminences, from the flexion fold of the wrist over a length of 5 cm.</description>
    <arm_group_label>WALANT</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Tourniquet</intervention_name>
    <description>inflation pressure 75 to 100 mmHg above systolic blood pressure.</description>
    <arm_group_label>CONTROL</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Ropivacaine</intervention_name>
    <description>troncular blocks with Ropivacaine 3.75 mg/ml</description>
    <arm_group_label>CONTROL</arm_group_label>
    <arm_group_label>WALANT</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Lidocaine + Epinephrine</intervention_name>
    <description>WALANT technique with 1% lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine</description>
    <arm_group_label>WALANT</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Patients undergoing endoscopic carpal tunnel release&#xD;
&#xD;
          -  Consent for participation&#xD;
&#xD;
          -  Affiliation to a social security system&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Chronic pain syndrome or fibromyalgia&#xD;
&#xD;
          -  Contraindication for locoregional anesthesia&#xD;
&#xD;
          -  ASA 4&#xD;
&#xD;
          -  Pregnant or breastfeeding women&#xD;
&#xD;
          -  Patients under protection of the adults(guardianship, curators or safeguard of&#xD;
             justice)&#xD;
&#xD;
          -  Communication difficulties or neuropsychiatric disorder&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>Clinique Jouvenet</name>
      <address>
        <city>Paris</city>
        <state>Ile-de-France</state>
        <zip>75016</zip>
        <country>France</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Clinique Rémusat</name>
      <address>
        <city>Paris</city>
        <state>Ile-de-France</state>
        <zip>75016</zip>
        <country>France</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>France</country>
  </location_countries>
  <verification_date>July 2021</verification_date>
  <study_first_submitted>July 28, 2020</study_first_submitted>
  <study_first_submitted_qc>July 28, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">July 31, 2020</study_first_posted>
  <last_update_submitted>July 21, 2021</last_update_submitted>
  <last_update_submitted_qc>July 21, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">July 23, 2021</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>WALANT</keyword>
  <keyword>Tourniquet</keyword>
  <keyword>Regional anesthesia</keyword>
  <keyword>Troncular blocks</keyword>
  <keyword>Postoperative Analgesia</keyword>
  <keyword>Ultrasound</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Carpal Tunnel Syndrome</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Lidocaine</mesh_term>
    <mesh_term>Epinephrine</mesh_term>
    <mesh_term>Ropivacaine</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04494100
org study id: 2020/02
nct id: NCT04494100
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
The carpal tunnel release (CTR) is now performed almost exclusively under regional anesthesia
      (RA) in France. RA requires the use of a pneumatic tourniquet to limit blood flow to the
      operated extremity and create a bloodless surgical field for a clear visualization of the
      anatomic structures by the surgeon.

      Multiple approaches to block the brachial plexus can be considered. The most common technique
      is the axillary block (BAX) that provides complete anesthesia for the patient's arm and
      forearm. This technique offers anesthesia not only for the surgical area but also for the
      root of the arm where the pneumatic tourniquet is placed. However this technique have limits:
      the persistence of a motor block in the arm and the forearm that is not compatible with a
      quick hospital discharge (short term ambulatory hospitalization) and the need for assistance
      with dressing and eating after surgery. More distal anesthetic techniques are proposed such
      as the troncular blocks (TRONC) that avoid motor block of the arm and offer an earlier
      recovery and autonomy for the patient. However, they lead to a poor tolerance to the
      tourniquet due to its application on a non-anesthetized area.The pain related to the pressure
      of the tourniquet can occur within the first few minutes of its inflation, get worse over
      time and persist for several minutes after its deflation. Therefore, TRONC procedure is less
      often performed compared to the BAX for major surgeries but it remains appropriate for CTR.

      The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique is widely used in Canada and
      has been proposed for hand and wirst minor surgeries. WALANT uses a combination of a local
      anesthetic (LA) and epinephrine to induce anesthesia and hemostasis in the area of the
      surgical procedure in order to allow surgeries to be done without the use of tourniquet.
      Epinephrine is a vasoconstrictor agent that reduces blood flow at surgical site. This
      bloodless effect is visualized on the skin by a pale color. Thus, WALANT can provide a
      chemical tourniquet and eliminate the pain from a traditional arm tourniquet. However, this
      technique is performed with a short-acting LA and does not offer any postoperative analgesia.

      The association of TRONC using long-acting LA with the WALANT technique could combine the
      comfort of a surgery without tourniquet to a long-acting analgesia and thus could provide a
      superior overall comfort.

      The main objective of this prospective, multicentre, randomized, open-label, parallel-group
      controlled trial is to evaluate the interest of WALANT technique on patient comfort during
      CTR performed with TRONC, compared to the tourniquet.
This is a multicenter, prospective, randomized, open-label study assessing the interest of
      the association of the WALANT local infiltration technique with analgesic troncular blocks
      (TRONC) at the wrist, for the endoscopic CTR.

      This study compares two groups:

        -  CONTROL group (usual technique) : TRONC (using a long-acting LA : Ropivacaine) +
           Tourniquet

        -  WALANT group (experimental technique) : TRONC (using a long-acting LA : Ropivacaine) +
           WALANT ( using a short-term LA : Lidocaine + epinephrine)

      RA procedures will be systematically performed under ultrasound guidance, 45 min befor
      surgery. Before each procedure, a skin disinfection will be carried out using an alcoholic
      iodine solution. The needle approach will be in-plane (IP) or out-of-plane (OOP). Efficiency
      will be assessed before transfer to the operating room.

        -  Troncular blocks (TRONC) Patients will be installed in supine position, the arm at 90°
           of abduction and in external rotation. The probe will be positioned to have an axial
           view of the nerves at the wrist. The initial identification of the median (nM) and ulnar
           (nU) nerves will be systematically done before each TRONC. The nM will be located on the
           anterior forearm. The nU will be visualized in contact with the ulnar artery in the
           forearm. The operator will inject 3 to 7 mL of Ropivacaine 3.75 mg/ml per nerve. An
           infiltration of 2 ml of Ropivacaine 3.75 mg/ml will be performed laterally above the
           flexion fold of the wrist in order to block the branches of the lateral cutaneous nerve
           of the forearm, the terminal sensory branch of the musculocutaneous nerve (nMC). A 22
           Gauge x 50 mm needle will be used for TRONC.

        -  WALANT infiltration ("WALANT" group) An infiltration of the subcutaneous area in front
           of the transverse ligament will be performed between the thenar and hypothenar
           eminences, from the flexion fold of the wrist over a length of 5 cm. The path of the nM
           in the palm of the hand will be checked before each procedure. 3 to 7 ml of 1% lidocaine
           (10 mg/ml) combined with 0.005 mg/ml epinephrine and 8.4% sodium bicarbonate (1 ml per
           10 ml of lidocaine) will be injected. The addition of sodium bicarbonate will reduce the
           pain due to lidocaine injection. A 24 Gauge x 50 mm needle will be used for WALANT.

        -  Usage of pneumatic Tourniquet A pneumatic tourniquet will be placed at the root of the
           arm in all patients. A cuff with size and shape adapted to the patient will be used. The
           tourniquet will be inflated in all patients of "CONTROL" group, and if necessary,
           corresponding to the failure of the WALANT technique, in patients of "WALANT" group. The
           inflation pressure will be determined according to the patient's systolic blood pressure
           (SBP). It will be inflated 75 to 100 mmHg above SBP
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Other
masking: None (Open Label)
measure: Patient comfort during CTR
time frame: 4 hours
description: Pain score using a Visual Analogue Sclae (VAS) ranging from 0 to 10 (0= completely painless, 10= extremely painfull).
measure: Quality of the endoscopic surgical procedure
time frame: 4 hours
description: Numeric Rating Scale (NRS) for visualization during endoscopic surgery ranging from 0 to 5 ( 0=very poor conditions; 5=optimal conditions)
measure: Troncular block success
time frame: 30 minutes
description: Sensory perception to pin-prick on the specific territories of the median, ulnar and radial nerves at 10, 20 and 30 minutes post injection using a 3-point rating: 0 = absence of block (sharp sensation to pinprick), 1 = analgesia (dull sensation to pinprick), 2 = anesthesia (loss of sensation to pinprick)The need for an additional block, an intraoperative surgical infiltration or a sedation will be noted.
measure: WALANT technique success
time frame: 30 minutes
description: Modification (or not) of the skin color near the injection area at 10, 20 and 30 minutes postinjection.
measure: Hemostasis quality for the WALANT group
time frame: 4 hours
description: Usage (or not) of tourniquet.
measure: Patient satisfaction
time frame: 4 hours
description: Patient satisfaction score collected in post-anesthesia care unit (PACU) using a Numeric Rating Scale (NRS-Satisfaction) ranging from 0 (very unsatisfied) to 10 (very satisfied).
measure: Surgery duration
time frame: 4 hours
description: Time (in minutes) between the skin incision and the last suture.
measure: Rate of complications
time frame: 20 days
description: Incidence of complications related to RA procedure
arm group label: CONTROL
arm group type: Active Comparator
description: Troncular blocks using a long-acting LA + Tourniquet
arm group label: WALANT
arm group type: Experimental
description: Troncular blocks using a long-acting LA + WALANT technique using a short-term LA with epinephrine a vasoconstrictor agent
intervention type: Procedure
intervention name: TRONC
description: injection of 3 to 7 mL of Ropivacaine 3.75 mg/ml per nerve (median and ulnar nerves) and infiltration of 2 ml of Ropivacaine 3.75 mg/ml laterally above the flexion fold of the wrist in order to block the branches of the lateral cutaneous nerve of the forearm, the terminal sensory branch of the musculocutaneous nerve.
arm group label: CONTROL
arm group label: WALANT
intervention type: Procedure
intervention name: WALANT
description: infiltration with 3 to 7 ml of 1% lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine and 8.4% sodium bicarbonate in the subcutaneous area in front of the transverse ligament, between the thenar and hypothenar eminences, from the flexion fold of the wrist over a length of 5 cm.
arm group label: WALANT
intervention type: Procedure
intervention name: Tourniquet
description: inflation pressure 75 to 100 mmHg above systolic blood pressure.
arm group label: CONTROL
intervention type: Drug
intervention name: Ropivacaine
description: troncular blocks with Ropivacaine 3.75 mg/ml
arm group label: CONTROL
arm group label: WALANT
intervention type: Drug
intervention name: Lidocaine + Epinephrine
description: WALANT technique with 1% lidocaine (10 mg/ml) combined with 0.005 mg/ml epinephrine
arm group label: WALANT
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
facility: 
facility: 
country: France
responsible party type: Sponsor
mesh term: Carpal Tunnel Syndrome
mesh term: Lidocaine
mesh term: Epinephrine
mesh term: Ropivacaine
sharing ipd: No