Complications After Clinic-Based Wide Awake Local Anesthesia No Tourniquet Hand Surgery at a Single Private Practice

Abstract

Background This study was designed to analyze the results of all wide awake local anesthesia no tourniquet (WALANT) procedures performed on the hand and wrist at a single practice hand surgery practice with a focus on quantifying and qualifying complications. Methods This retrospective chart review included 424 patients who underwent WALANT hand procedures in the minor procedure room of our private practice between 2015 and 2017. Patients were divided into groups based on the type of procedure, including carpal tunnel release, A1 pulley release, first dorsal compartment release, extensor tendon repair, mass excision, and foreign body removal. Data pertaining to patient demographics and complications were recorded. Results The overall complication rate for all procedures was 2.8% for 424 patients: A1 pulley release (n = 314, 2.5%), first dorsal compartment release (n = 11, 9%), extensor tendon repairs (5.5%), and mass excision (4%). The carpal tunnel release and foreign body removal groups experienced no complications. No adverse events (arrhythmias, vasovagal, etc.) were observed during the use of the WALANT technique. Conclusions Clinic-based WALANT hand surgery procedures are equally safe compared to the same procedures performed in the operating room at an ambulatory surgery center or hospital.

Impact of WALANT Hand Surgery in a Secondary Care Hospital in Spain. Benefits to the Patient and the Health System

“…The combination of lidocaine with adrenaline and its use in the most common surgical procedures in hand surgery has gained popularity in recent years since its widespread use for flexor repair, and its use is expanding to an increasing number of more and more complex surgeries. 9 , 10 , 29 , 30 , 31 Its safety has been demonstrated in several studies. 14 The cases of skin necrosis published before 1950 were related to the acidity of procaine.…”

“…Very few studies have documented complications after WALANT TF release. Reynolds et al 29 published a study in 2020 in which they assessed 314 surgical releases of the A1 pulley with WALANT, among other interventions, and observed 8 complications (2.5%).…”

Current Evidence Involving WALANT Surgery

“…Similarly, in Maliha et al's 31 retrospective review analyzing 76 trigger finger releases (39 under WALANT and 37 under LAWT with sedation or GA), there were no differences in intraoperative or postoperative complications between the 2 groups; both demonstrated similar rates of postoperative paresthesia (2.7% vs 2.7%), infection (0%), and recurrent triggering (5.13% vs 2.7%; P ¼ .572). 31 In a study by Reynolds et al, 33 424 patients who underwent WALANT hand surgery (trigger finger releases, first dorsal compartment releases, extensor tendon repairs, mass excisions, and carpal tunnel releases) were retrospectively reviewed, examining rates of complications after surgery. Amongst all procedures, the overall complication rate was 2.8%, and included 6 superficial infections treated with oral antibiotics, 2 deep infections requiring surgical incision and drainage, and 4 recurrences requiring reoperation.…”