Plating Distal Radius Fractures Using Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus General Anesthesia: A Cohort Study

Abstract

This study compared outcomes of plating distal radius (DR) fractures using wide-awake local anesthesia no tourniquet (WALANT) versus general anesthesia (GA). Methods: From March 2018 to March 2019, 20 patients with DR fracture underwent plating using WALANT whereas 20 patients who underwent plating under GA were used as controls. Outcomes evaluated were pain control, waiting time for the operation, hemodynamic changes, blood loss, the occurrence of adverse effects of medications used in WALANT and GA, and the duration of postoperative stay. Results: The WALANT group experienced a significantly shorter waiting time for surgery (6 vs 20 days; P < .001) and a shorter postoperative stay (1 vs 2 days; P ¼ .009) compared with the GA group. They also reported mild to no pain during surgery. The groups were similar with regard to blood pressure, blood loss, and operative time. None in the WALANT group required conversion to GA during surgery and no adverse effects were reported. Conclusions: The WALANT approach is a viable alternative to GA for plating of DR fractures. Type of study/level of evidence: Therapeutic 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

“…WALANT is usually employed in soft tissue procedures such as excision of a ganglion cyst or for a carpal tunnel release that do not require a tourniquet. Recently, WALANT has been utilised as an alternative to GA for bony fixation especially of the distal end [ 2 , 8 - 12 ]. In this study, we attempted to compare the differences in preoperative anxiety, the operation time, the blood loss, the functional outcome using the QuickDASH score and the wrist ROM after distal radius plating via WALANT or GA.…”

“…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 ].…”

“…Therefore, with the advantages listed above, WALANT provides an excellent alternative to general anesthesia (GA) in the treatment of distal end radius fractures. There is a limited number of studies comparing GA, WALANT, regional block and Bier’s block in distal radius plating [ 2 , 8 - 12 ].…”

“…GA is associated with a number of complications while requires a series of preoperative investigations. WALANT can provide an alternative form of anesthesia avoiding common complications of GA such as nausea and vomiting and allowing high-risk patients to avoid GA [ 2 , 8 - 12 ]. Surgery under WALANT should be avoided in patients with a history of lignocaine allergy, anxiety disorder or peripheral vascular disease as it may cause peripheral ischaemia.…”