Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet

Gunasagaran, Jayaletchumi; Sean, Ee Soon; Shivdas, Sachin; Amir, Shams; Ahmad, Tunku Sara

doi:10.1177/2309499017739499

Cited by 82 publications

(85 citation statements)

References 17 publications

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“…Thus, a wide-awake local anesthesia with no tourniquet procedure was developed. The WALANT technique has been used in different hand surgeries, particularly in soft tissue repair or reconstruction [ 1 , 16 – 20 ]. In addition, finger fractures could be also treated by closed reduction and percutaneous pinning under WALANT technique [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

et al. 2018

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BackgroundThe wide-awake local anesthesia no tourniquet (WALANT) technique is applied during various hand surgeries. We investigated the perioperative variables and clinical outcomes of open reduction and internal fixation (ORIF) for distal radius fractures under WALANT.MethodsFrom January 2015 to January 2017, 60 patients with distal radius fractures were treated, and 24 patients (40% of all) were treated with either a volar or a dorsal plate via WALANT procedure. Of these 24 patients, 21 radius fractures were fixed with a volar plate, and the other 3 were fixed with a dorsal plate. Radiographs; range of motions; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire; and time to union were evaluated.ResultsOne of the 24 patients could not tolerate the WALANT procedure and was reported as a failed attempt at WALANT. In the cohort, 23 patients successfully received distal radius ORIF under WALANT procedure. The average age is 60.9 (range, 20–88) years. The average operation time was 64.3 (range, 45–85) minutes, the average blood loss was 18.9 (range, 5–30) ml, and the average of duration of hospitalization is 1.8 (range, 1–6) days. The average postoperative day one VAS was 1.6 (range, 1–3). The average time of union was 20.7 (range, 15–32) weeks. The mean follow-up period was 15.1 (range, 12–24) months. Functional 1-year postoperative outcomes revealed an average Quick DASH score of 7.60 (range, 4.5–13.6) and an average wrist flexion and extension of 69.6° (range, 55–80°) and 57.4° (range, 45–70°). There was no wound infection, neurovascular injury, or other major complication noted.ConclusionsWALANT for distal radius fracture ORIF is a method to control blood loss by the effects of local anesthesia mixed with hemostatic agents. Without a tourniquet, the procedure prevents discomfort caused by tourniquet pain. Without sedation, patients could perform the active range of motion of the injured wrist to check if there is impingement of implants. It eliminates the need of numerous preoperative examinations, postoperative anesthesia recovery room care, and side effects of the sedation. However, patients who are not amenable to the awake procedure are contraindications.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0903-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

et al. 2018

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“…Nevertheless, Iqbal et al (14) published a study in 2018 in which they randomized Carpal tunnel release cases to undergo either local anesthesia plus adrenaline or local anesthesia plus tourniquet and they found that early pain score was significantly higher in the latter group. Gunasagaran et al (15) compared WALANT technique to local anesthesia plus tourniquet in 72 cases with minor hand surgery and they reported lower early postoperative pain in subjects undergoing WALANT technique. Consistent with the literature, our findings may be attributed the prolongation of postoperative analgesic time with adrenaline and/or aggravation of postoperative pain level by tourniquet application.…”

Section: Discussionmentioning

confidence: 99%

“…Other advantages of the technique include avoidance of tourniquet-related pain and other complications and evaluation of perioperative active movements via patient cooperation. Finger fracture fixation, tendon repair or transfer, arthrodesis, arthroplasty, release of median nerve and trigger finger could be performed with this technique (15). In this study, we performed open median nerve release with this technique.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Wide Awake Local Anaesthesia No Tourniquet Technique with Tourniquet Application under General Anesthesia in Carpal Tunnel Syndrome: A Retrospective Study

Kır¹,

Bayraktar²,

Gürbüz³

2019

eamr

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Objective: Carpal tunnel syndrome is a common complaint in orthopedic practice and usually treated with surgical intervention. The aim of the study was to compare wide awake local anesthesia no tourniquet (WALANT) technique with general anesthesia and arm tourniquet in Carpal tunnel cases. Methods: Fifty-two patients who underwent surgery for Carpal tunnel syndrome were retrospectively divided into two groups as WALANT technique (Group W) and general anesthesia with arm tourniquet (Group G). In addition to the demographic data, visual analog scale (VAS), opioid consumption, early complications, duration of stay in operating room (DSOR) and first analgesic need time were evaluated. Results: When both groups were evaluated, early postoperative VAS scores, opioid consumption and DSOR were significantly lower in Group W than in Group G. Conclusion: In conclusion, WALANT technique was associated with reduced early postoperative pain, lower DSOR and opioid consumption compared to general anesthesia with tourniquet method for carpal tunnel release.

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“…The study, however, involved different procedures on a variety of cases such as carpal tunnel, trigger finger, and ganglion. 5…”

Section: Introductionmentioning

confidence: 99%

“…12 Usage of tourniquet causes intraoperative pain to patients; hence, with this new practice where a tourniquet is not required, one can be more comfortable doing the surgery without the risks and pain of tourniquet, resulting in a better patient experience. 5,13…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline

Rashid

Sapuan

Abdullah

2019

J Orthop Surg (Hong Kong)

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Background: Trigger finger release utilizing wide-awake local anesthesia no tourniquet (WALANT) usage in extremity surgery is not widely used in our setting due to the possibility of necrosis. Usage of a tourniquet is generally acceptable for providing surgical field hemostasis. We evaluate hemostasis score, surgical field visibility, onset and duration of anesthesia, pain score, and the duration of surgery and potential side effects of WALANT. Methods: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1–10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded. Results: Hemostasis score was grouped into visibility score as 1–3: good, 4–6: moderate, and 7–10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference. Conclusion: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.

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Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet

Abstract: WALANT technique was associated with better patient comfort. Tourniquet was the main reason for discomfort during surgeries. WALANT is an alternative in minor hand surgeries for a bloodless surgical field without the discomfort of tourniquet application.

Cited by 82 publications

References 17 publications

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

Comparison of Wide Awake Local Anaesthesia No Tourniquet Technique with Tourniquet Application under General Anesthesia in Carpal Tunnel Syndrome: A Retrospective Study

A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline

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