Wrist arthroscopy can be performed under general, regiona orl local anesthesia as
well as with the WALANT (wide-awake, local anesthesia, no tourniquet) technique. In
choosing the type of anesthesia and analgesia one should take into consideration
that a tourniquet must be applied at the distal arm (although, in our practice, most of
the times it is not inflated) as well as the need for 6 kg of traction to the upper
extremity. One also has to consider the patient’s age, medical comorbidities, anxiety
level as well as the expected duration of the procedure. Finally, the possibility of the
need to temporary stabilize carpal bones with percutaneous K-wires should be kept
in mind even if it is not anticipated from the beginning of the case.

In our practice, the most common forms of anesthesia are either general with
postoperative local analgesia (ropivacaine) infiltration or ultrasound guided
infraclavicular block and sedation. The latter has the advantage of postoperative
analgesia but the disadvantage of poor motor control of the whole extremity for a few
hours. We would generally advise against performing wrist arthroscopy under local
or WALANT, unless for a diagnostic or a very simple procedure. Choosing general
anesthesia for a junior surgeon’s first wrist arthroscopy cases, reduces the anxiety
levels of both the patient and the surgeon.