Effective Things Surgeons Can Tell Patients During Wide-Awake Local Anesthesia No Tourniquet Surgery to Decrease Complications and Improve Outcomes

Lalonde, Donald H.

doi:10.1016/j.jhsg.2022.04.009

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…For bloodier procedures such as palmar fasciectomy for Dupuytren's contracture, you may want to wait 45-60 min for better vasoconstriction Be kind to your patients during the local injection and the surgery A kind, calm, matter-of-fact approach by the surgeon and nurses can provide an experience better than sedation 50 Intraoperative education by the surgeon on how to behave after surgery for optimal results will provide better outcomes 51 Tell your patients that the local anesthesia will hardly hurt at all, and that the surgery will not hurt…”

Section: Wide-awake Tendon Surgerymentioning

confidence: 99%

New Frontiers in Wide-Awake Surgery

Lalonde,

Gruber,

Ahmad

et al. 2024

Plastic &Amp; Reconstructive Surgery

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Learning Objectives: After studying this article, the participant should be able to: 1. Explain the most important benefits of wide-awake surgery to patients. 2. Tumesce large parts of the body with minimal pain local anesthesia injection technique to eliminate the need for sedation for many operations. 3. Apply tourniquet-free surgery to upper and lower limb operations to avoid the sedation required to tolerate tourniquet pain. 4. Move many procedures out of the main operating room to minor procedure rooms with no increase in infection rates to decrease unnecessary cost and solid waste in surgery. Summary: Three disruptive innovations are changing the landscape of surgery: (1) minimally painful injection of large-volume, low-concentration tumescent local anesthesia eliminates the need for sedation for many procedures over the entire body; (2) epinephrine vasoconstriction in tumescent local anesthesia is a good alternative to the tourniquet and proximal nerve blocks in extremity surgery (sedation for tourniquet pain is no longer required for many procedures); and (3) evidence-based sterility and the elimination of sedation enable many larger procedures to move out of the main operating room into minor procedure rooms with no increase in infection rates. This continuing medical education article explores some of the new frontiers in which these changes affect surgery all over the body.

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Section: Wide-awake Tendon Surgerymentioning

confidence: 99%

New Frontiers in Wide-Awake Surgery

Lalonde,

Gruber,

Ahmad

et al. 2024

Plastic &Amp; Reconstructive Surgery

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“…In ASA 3 or 4 patients with important comorbidities, WALANT makes hand surgery safe and possible when systemic sedation is considered too risky (23). Being awake and alert, the patient can gain insight into his condition and therapy, which will help in postoperative rehabilitation (24).…”

Section: Advantagesmentioning

confidence: 99%

“…This instructional lecture did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector. https://doi.org/10.1530/EOR- 24…”

Section: Funding Statementmentioning

confidence: 99%

WALANT surgery of the hand: state of the art

Degreef,

Lalonde

2024

EFORT Open Reviews

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Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25–1% lidocaine, with 1:100 000–1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.

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“…Most wide-awake patients welcome the opportunity to have a dialog with their surgeon intraoperatively, and many hand surgeons effectively use the operative time to describe surgical findings, demonstrate improved range of motion, or provide postoperative instructions to their patients 75 . On the other hand, patients who are apprehensive about wide-awake anesthesia may experience less anxiety by listening to music through headphones or by using virtual reality distractions during the procedure 76-78 .…”

Section: Potential Disadvantages Of Walantmentioning

confidence: 99%

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

2023

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» Wide-awake local anesthesia no tourniquet (WALANT) technique featuring tumescent infiltration of lidocaine with epinephrine at the operative site has broad application in hand surgery including both soft-tissue and bone procedures.» The advantages of wide-awake anesthesia include high patient satisfaction, preserved intraoperative finger and wrist motion, cost-effectiveness, improved operating room efficiency, fewer opioids during recovery, and improved access to hand surgery, which may be performed in an office-based setting without the need for anesthesia personnel.» In properly selected patients, use of lidocaine with epinephrine in the hand and fingers is safe. Rare postprocedure digital ischemia may be effectively treated with phentolamine rescue.» Barriers to adopting wide-awake anesthesia may be overcome by educating resistant stakeholders, including hospital administrators, nurse leaders, and anesthesia colleagues, about the advantages of the WALANT method.» The risk of postoperative complications after hand procedures may be mitigated by using the wide-awake technique instead of regional anesthesia with sedation or general anesthesia.

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Effective Things Surgeons Can Tell Patients During Wide-Awake Local Anesthesia No Tourniquet Surgery to Decrease Complications and Improve Outcomes

Cited by 4 publications

References 12 publications

New Frontiers in Wide-Awake Surgery

New Frontiers in Wide-Awake Surgery

WALANT surgery of the hand: state of the art

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

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