Carpal tunnel syndrome is commonly treated by a mini-open or endoscopic procedure. It has been demonstrated that an ultrasound guidance permits assessment of a precise anatomical diagnosis in of the carpal tunnel, avoiding nervous lesions, and controlling the complete release of the median nerve. The aim of this study is to evaluate the feasibility and the advantages of a wide-awake technique and thus to validate an original ultra fast track procedure for patient who suffer of a carpal tunnel syndrome. In a prospective study, 100 people (15 men and 85 women, mean age 62 years old) were treated between November 2015 and May 2015 with an ultrasound-guided percutaneous procedure by two surgeons. All the patients have had a clinical examination and a conduction study. None of the patient was fasting. The procedure has been performed for all patients with a modified wide-awake protocol of anesthesia (local anesthesia with epinephrine, associated with a median nerve blockade at the wrist) and without tourniquet named Wide Awake Local Anesthesia with No Tourniquet (WALANT). None received a sedation. The carpal release was performed with a Kemisy knife (NewClip Technics™, France). The progression of the knife was controlled with the high frequency ultrasound probe (6–15MHz). A picture of the knife through the retinaculum was taken as evidence of the complete release. All the patients go directly to the nursing ward and are allowed to leave this unit after 15min. Time to leave the unit of hand surgery was noted.

All the patients have had a good clinical result. None of them complained of any pain during de procedure. There was no nervous injury. All the clinical parameters were the same compared to traditional carpal tunnel release. None of the patients complained about reflex sympathetic dystrophy. The mean duration time to leave was 32min (15–68). In conclusion, the study emphases that ultrasound guide carpal tunnel release is a safe method. Moreover, this surgery may be done without tourniquet and with a limited anesthesia. Patients have had an immediate functional recovery of the hand that allowed to spend a very short time in the day surgery ward. Further study could be assessed to point out the possibility to reduced drastically the cost of the carpal tunnel syndrome with the use of an ultra fast track procedure allowed by ultrasound guided surgery with wide awake plus approach.