Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique

Abstract

Aims We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue. Methods This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier’s block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant. Results Operations with WALANT proceeded sooner, and patients recovered faster, resulting in mean fewer missed working days (7.8 (SD 1.67)) compared with general anaesthesia (20.1 (SD 7.37)) or Bier’s block (14.1 (SD 7.65)) (p < 0.001). The WALANT patients did not develop complications, while the other patients did (p < 0.04). Clinical outcomes did not differ, nor did surgeon qualification affect clinical outcomes. Mean hospital costs were lower for WALANT ($428.50 (SD 77.71)) than for general anaesthesia ($630.63 (SD 114.77)) or Bier’s block ($734.00 (SD 37.54)) (p < 0.001). Patient satisfaction was also higher (p < 0.001). Conclusion WALANT for distal radius fractures results in a faster recovery, is more cost-effective, has similar clinical outcomes, and has fewer complications than general anaesthesia or Bier's block. This makes WALANT an attractive technique in any setting, but especially in middle- and low-income countries. Cite this article: Bone Joint Res 2020;9(7):429–439.

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 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.…”

“…None of the patients in the WALANT group required conversion to general GA in contrast to Tahir et al’s study where two patients were converted to GA [ 11 ].…”

“…Both were lower than the average amount of blood loss reported in a study by Huang et al [ 2 ]. In contrast, Tahir et al’s study reported a much higher amount of blood loss at a mean average of 23.4 mL in the WALANT group compared to GA and Bier’s block groups [ 11 ].…”

“…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 ].…”

“…The average pain score post-operatively was about 1.6 in Huang et al’s study [ 2 ] , but this score was only during the first post-operative day. 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 ].…”