Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia

Abstract

Surgical fixation of distal radius fractures under local anaesthesia with the patient wide awake allows an intraoperative testing of the fixation stability under active mobilization. We evaluated the feasibility and clinical results of this technique in 45 patients prospectively in two matched comparable groups: wide-awake local anaesthesia no tourniquet and loco-regional anaesthesia. We found that the pain scores during the anaesthetic administration and the surgical procedure were similar in two groups. Ranges of wrist motion and QuickDASH scores were improved significantly in the wide-awake local anaesthesia no tourniquet group at 6 weeks and 3 months and similar at 6 months compared with those receiving loco-regional anaesthesia. Patients in wide-awake local anaesthesia no tourniquet returned to work significantly earlier than the loco-regional anaesthesia group. We conclude that osteosynthesis of distal radius fractures can be safely performed under wide-awake local anaesthesia no tourniquet, leading to no increase in pain level and similar functional outcomes compared with those under loco-regional anaesthesia. Level of evidence: III

A Randomized Controlled Trial Comparing Wide-Awake Local Anesthesia With No Tourniquet (WALANT) to General Anesthesia in Plating of Distal Radius Fractures With Pain and Anxiety Level Perception

“…The average range of motion of the wrist (flexion, extension, supination and pronation) recorded at three weeks, six weeks, three months and six months also showed a significant improvement similar to Dukan’s study that reported better wrist range of motion and QuickDASH scores and an earlier return to work [ 10 ]. In contrast, the clinical outcomes in Tahir et al’s study were not affected by the type of anesthesia [ 11 ].…”

“…The average operative time was longer for the WALANT group (61.22 min) compared to the GA group (55.3 min) and the difference was statistically significant (p = 0.003). Previous studies by Dukan et al and Tahir et al found no difference in the operative time between WALANT and GA groups [ 10 , 11 ]. Both GA (n = 14) and WALANT (n = 11) groups had similar AO C2 type of radius fracture.…”

“…Patients from Tahir et al’s study received oral tramadol 37.5 mg/325 mg acetaminophen combination tablets two times a day and had a mean VAS pain score of 1.2 at 24 hours post-surgery compared to 3.0 for the GA and 2.2 for the Bier’s block group [ 11 ]. Dukan et al’s study reported similar pain scores for the WALANT and the regional anesthesia groups [ 10 ].…”

“…We did not need to add any more WALANT solution. Both studies by Dukan et al and Yi et al had a few patients with mild pain (ranging from VAS 1 to 4) with pain worsening upon aggressive manipulation and drilling of bone [ 10 , 12 ]. Two patients required additional local anesthesia (WALANT) in Dukan’s study [ 10 ] and four patients in Yi et al’s study [ 12 ].…”

“…Both studies by Dukan et al and Yi et al had a few patients with mild pain (ranging from VAS 1 to 4) with pain worsening upon aggressive manipulation and drilling of bone [ 10 , 12 ]. Two patients required additional local anesthesia (WALANT) in Dukan’s study [ 10 ] and four patients in Yi et al’s study [ 12 ]. The Tahir et al study reported a mean highest intraoperative VAS score at 3.5 and yet, this was still lower than the 4.4 score of their Bier’s block group [ 11 ].…”