Successful Boutonniere Reconstruction With Wide-Awake Local Anesthesia No Tourniquet

Baş, Can Emre; Ayhan, Egemen; Kunu, Orhan; Kuru, Cigdem Ayhan

doi:10.1016/j.jhsg.2022.05.001

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…The upper limb remains under motor control by the wide awake patient. He can help by moving reconstructed parts actively during the surgery, when certain procedures need balanced fixation or tension of joints and tendons, such as in flexor tendon repair, boutonniere fingers, or in tendon transfers (25,26,27,28). Pain control persists after surgery, diminishing the need for opioids when compared to general or regional anesthesia (29,30,31,32).…”

Section: Local Anesthesia: the Numbness Is Administeredmentioning

confidence: 99%

“…However, this is impossible to evaluate if the hand is paralyzed, and the necessity to add a PIP stabilizing soft tissue procedure is unpredictable. Boutonniere deformity may be even more challenging (26). The classical four-step Curtis procedure, where every step needs to be tested dynamically to steer decision-making, is only possible in active testing by the patient as is only possible with WALANT (69).…”

Section: Double Joint Dysfunctionmentioning

confidence: 99%

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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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Section: Local Anesthesia: the Numbness Is Administeredmentioning

confidence: 99%

Section: Double Joint Dysfunctionmentioning

confidence: 99%

WALANT surgery of the hand: state of the art

Degreef,

Lalonde

2024

EFORT Open Reviews

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“…Surgery under wide-awake local anesthesia no tourniquet enables the hand surgeon to check the stability of the repair, and early active motion with relative motion flexion splint/orthosis can be started. 4…”

mentioning

confidence: 99%

“…Surgery under wideawake local anesthesia no tourniquet enables the hand surgeon to check the stability of the repair, and early active motion with relative motion flexion splint/orthosis can be started. 4 In Japan, which is adjacent to Korea, the prevalence of boutonniere deformity without rheumatoid arthritis or trauma was 13%, and the deformity was associated with advanced age and a narrow EPB tendon. 5 Anak No.…”

mentioning

confidence: 99%

Boutonniere Deformity Depicted in a Koguryo Tomb Mural of the Anak Area of North Korea

Hwang

2023

Plastic and Reconstructive Surgery - Global Open

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Complications and side effects of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta-analysis

Lawand,

Hantouly,

Bouri

et al. 2024

International Orthopaedics (SICOT)

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Purpose Wide-Awake Local Anaesthesia No Tourniquet (WALANT), a groundbreaking anaesthetic technique resurging in practice, warrants a comprehensive safety analysis for informed adoption. Our study aimed to identify complications/side effects of WALANT upper limb procedures through a systematic review and meta-analysis. Methods This PROSPERO-registered study was performed with strict adherence to PRISMA guidelines. Embase, OVIDMedline, Cochrane, Web of Science, and Scopus databases were searched until February 2023. Inclusion criteria involved English articles, reporting complications/side effects in primary WALANT upper limb surgeries. Outcomes included all complications and side effects, data on the anaesthetic mixture, publication year/location, study type, and procedures performed. The meta-analysis employed the Freeman-Tukey Double Arcsine Transformation, computed I2 statistics, and utilized common or random effects models for pooled analysis. Results 2002 studies were identified; 79 studies met the inclusion criteria representing 15,595 WALANT patients. A total of 301 patients had complications, and the meta-analysis using a random effects model provided a complication rate of 1.7% (95% CI: 0.93–2.7%). The most reported complications were superficial infection (41%, n = 123/300), other/specified (12%, n = 37/300), and recurrent disease (6.7%, n = 20/300). A decade-by-decade analysis revealed no statistically significant difference in complication rates spanning the last three decades (p = 0.42). Adding sodium bicarbonate to the anaesthetic solution significantly reduced postoperative complications (p = 0.025). Conclusion WALANT has a low overall complication rate of 1.7%, with no significant temporal variation and a significant reduction in complications when sodium bicarbonate is added to the anaesthetic solution. Our findings support the safety of WALANT in upper limb procedures. Registration PROSPERO: CRD42023404018.

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Successful Boutonniere Reconstruction With Wide-Awake Local Anesthesia No Tourniquet

Cited by 4 publications

References 15 publications

WALANT surgery of the hand: state of the art

WALANT surgery of the hand: state of the art

Boutonniere Deformity Depicted in a Koguryo Tomb Mural of the Anak Area of North Korea

Complications and side effects of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta-analysis

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