Evaluating Clinical Outcomes for Determining the Optimal Delay to Skin Incision under WALANT: A Prospective Series of 34 Patients from a Low-Resource Tertiary Setting

Abstract

Background. Additional studies on clinical outcomes to determine the optimal time delay from injection of local anesthesia to skin incision for WALANT surgeries are needed. The authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. Methods. Thirty-four patients were consecutively recruited and allocated by either 7-min or 30-min delay for skin incision from local injection of epinephrine with lidocaine. Intraoperative bleeding and postoperative pain scores were analyzed between both groups by Mann–Whitney U-test, while complication rates were compared using Fisher’s exact test. Results. The present study did not find significant differences in mean intraoperative blood loss (8 ± 5.8 mL vs. 5 ± 2.2 mL, p=0.074), complication rates (18% vs. 0%, p=0.227), and mean pain scores (1.2 ± 0.5 vs. 1.4 ± 0.5, p=0.307) between the 7-min and 30-min groups. Conclusion. The authors conclude that a waiting time of 7 min from the injection of local anesthesia is sufficient to achieve comparable clinical outcomes for minor hand and wrist surgeries under WALANT.

Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations

“…Some quote 26 minutes from injection to optimal visibility. 28 In contrast, others suggest there is no difference in waiting 7 minutes versus 30 minutes after injection, 29 whereas others still found “good enough” visibility was achieved in between 5 and 15 minutes. 30 A balance between surgical efficiency and waiting for optimum vasoconstriction is required, requiring each surgeon to personalize their practice.…”

“…Carpal tunnel release Tulipan, 45 Sraj, 46 Kang, 47 Via, 48 Chapman, 49 Kazmers, 50 Gunasagaran, 26 Hernandez, 29 Ki Lee, 39 Shulman, 3 Rhee, 51 Mckee First dorsal compartment release Ki Lee, 39 Shulman, 3 Rhee 40…”

“…Phalangeal fracture Tang, 30 Khor 31 Flexor tendon repair/transfer Gueffier, 32 Mohammed, 33 Woo, 34 Tang, 30 Khor 31 Extensor tendon repair/transfer Miyashima, 35 Abdullah, 24 Mohammed, 33 Woo, 34 Tang, 30 Khor 31 Digital nerve Sawhney, 36 Tang, 30 Khor 31 Trigger finger Mohd, 27 Maliha, 37 Gunasagaran, 26 Hernandez, 29 Codding, 38 Ki Lee, 39 Shulman, 3 Rhee, 40 Tang, 30 Burn 41…”

How long to wait after local infiltration anaesthesia: systematic review

“…In the hand, successful hypoperfusion was achieved by waiting around 30 min 27 , 30 . The maximum blood loss was approximately double when waiting 7.0 min as compared to 30.0 min 30 .…”

WALANT – Wide Awake Local Anaesthesia No Tourniquet: Komplikationen bei elektiven und akut-traumatologischen handchirurgischen Eingriffen

“…Generell ist hierzu die Wirksamkeit des Adrenalins und die gute Übersicht im OP-Feld sehr gut nachgewiesen 16 , 17 . Hierzu ist allerdings eine gewisse Einwirkzeit nach Injektion nicht zu unterschreiten 18 , 19 . Bei einer Einwirkzeit von mindestens 30 Minuten traten bei Standardeingriffen in dieser Studie keine Probleme auf.…”