Is it safe to use local anesthesia with adrenaline in hand surgery? WALANT technique

Abstract

In the past it was taught that local anesthetic should not be used with adrenaline for procedures in the extremities. This dogma is transmitted from generation to generation. Its truth has not been questioned, nor the source of the doubt. In many situations the benefit of use was not understood, because it was often thought that it was not necessary to prolong the anesthetic effect, since the procedures were mostly of short duration. After the disclosure of studies of Canadian surgeons, came to understand that the benefits went beyond the time of anesthesia. The WALANT technique allows a surgical field without bleeding, possibility of information exchange with the patient during the procedure, reduction of waste material, reduction of costs, and improvement of safety. Thus, after passing through the initial phase of the doubts in the use of this technique, the authors verified its benefits and the patients’ satisfaction in being able to immediately return home after the procedures.

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

“…In addition, patients may experience a vasovagal syncope adverse reaction as a result of the injection. 80 As a result, in our practice, we recommend patients undergo injections while supine. Surgeons should be prepared to counsel patients who may experience these symptoms, and instruct them to lie down and or/elevate their feet to increase cerebral irrigation.…”

“…Surgeons should be prepared to counsel patients who may experience these symptoms, and instruct them to lie down and or/elevate their feet to increase cerebral irrigation. 80 Furthermore, if patients experience adverse symptoms before or during surgery, surgeons must be prepared to provide monitoring to ensure patient safety.…”

Evidenced-based local anaesthesia—is there a difference in practice between specialties in a major trauma centre?

“…Procaine is a LA which is quite acidic, with a pH of 3.6, which can acidify to a pH of 1 with prolonged storage. It is likely that the acidic nature of this LA would be the causative agent for the historical reports of finger necrosis and not due to the combined effect of adrenaline with it [ 12 , 13 ]. Twenty-one cases of digital necrosis with adrenaline as well as a LA have been reported.…”

“…Twenty-one cases of digital necrosis with adrenaline as well as a LA have been reported. Most of which occurred before 1950, and all involved the use of procaine or cocaine which could have been expired, therefore, had an extremely low pH [ 12 ]. Thomson et al [ 14 ] reported that this could have led to cause of the digital necrosis as it becomes more acidic with age.…”

Use of WALLANT technique in hand surgery, safe and advantageous. Personal experience

“…The cost of preoperative preparation decreases substantially as no preanesthetic assessment is required when using locoregional anesthesia (axillary, infraclavicular blocks) (13). The fact that this type of anesthesia avoids the use of tourniquet has several advantages: absence of pain or discomfort associated with tourniquets, a more comfortable position on the operating table and adaptable in case of patients with articular rheumatic diseases who do not tolerate certain positions on the operating table, avoidance of bleeding after tourniquet deflation (14,15). Among the advantages of this technique are also the short onset time of anesthesia, the possibility of intraoperative cooperation with the patient, accurate assessment of hand and finger movements (in the case of tenorrhaphies or tenoplasties) (16,17).…”