CONSENSUS RECOMMENDATION There are no randomized trials of draping options or field sterility relevant to this question. Multiple case series of WALANT surgeries, including carpal tunnel release, have shown low infection rates using field sterility. Given the well-documented cost savings of in-office carpal tunnel release using field sterility and the low reported infection rates for carpal tunnel release in general, it is our opinion that field sterility should be considered adequate for performance of carpal tunnel release surgery.
Benefits/Harms of Implementation
Given the low risk of infection in CTR overall, the harms are minimal. Benefits apply largely to efficiency and cost of in-office or surgical suite CTR surgery where full operative draping may not be feasible.
Cost Effectiveness/Resource Utilization
Field sterility or minimal draping is less expensive than full operative draping and contributes to the cost-effectiveness of CTR.
Acceptability
Well accepted approach in the literature in multiple health system settings.
Feasibility
No feasibility issues are expected as this approach minimizes the use of potentially unnecessary draping.
Future Research
Randomized controlled trials of field sterility in hand surgery are lacking and would strengthen the evidence against their use.