The use of the wide-awake local anesthesia no tourniquet technique in foot and ankle injuries

Bilgetekin, Yenel Gürkan; Kuzucu, Yakup; Öztürk, Alper; Yüksel, Sinan; Atilla, Halis Atıl; Ersan, Önder

doi:10.1016/j.fas.2020.07.002

Cited by 28 publications

(27 citation statements)

References 19 publications

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“…Davison et al 3 found that patients undergoing WALANT for carpal tunnel release (CTR) reported lower preoperative anxiety than patients receiving intravenous sedation (2.3 ± 2.68 versus 3.4 ± 2.81, P = 0.007), as reported on a visual analog scale (0–10; 0 = lowest, 10 = highest) ( P = 0.007), and found no difference in preoperative and intraoperative anxiety among wide-awake patients (2.3 ± 2.68 versus 2.1 ± 2.49, P > 0.05). Bilgetekin et al 44 reported a median visual analog anxiety score of 1 (range 0–3) during surgery for patients undergoing foot and ankle injury repair using WALANT. Similarly, in a postoperative questionnaire, Teo et al 50 found that patients who had undergone WALANT for various hand procedures reported low levels of anxiety during their experience and described their pain during surgery as similar to a dental procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Li et al 43 reported no complications when using WALANT for ORIF of ankle fractures. Bilgetekin et al 44 used WALANT for medial malleolus fractures, lateral malleolus fractures, Achilles tendon ruptures, Lisfranc injury, medial malleolus + syndesmotic injury, deltoid ligament + syndesmotic injury, and fifth metatarsal fractures. The authors reported a median visual analog pain score of 1 (range 0–4) during surgery and no complications.…”

Section: Diverse Applicationmentioning

confidence: 99%

“…The authors reported a median visual analog pain score of 1 (range 0–4) during surgery and no complications. 44 Poggetti et al 45 conducted a randomized study of 60 patients who underwent distal fibula hardware removal. Compared to the locoregional anesthesia with the tourniquet group, the WALANT group experienced significantly reduced postoperative pain and no difference in postoperative complication rates.…”

Section: Diverse Applicationmentioning

confidence: 99%

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Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Kurtzman

Etcheson

Koehler

2021

Plastic and Reconstructive Surgery - Global Open

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Background: The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT. Methods: A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety. Results: The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates. Conclusions: The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Diverse Applicationmentioning

confidence: 99%

Section: Diverse Applicationmentioning

confidence: 99%

See 1 more Smart Citation

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Kurtzman

Etcheson

Koehler

2021

Plastic and Reconstructive Surgery - Global Open

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“…[8][9][10][11][12] Wide-awake local anesthesia no tourniquet (WALANT) surgery is well established in hand surgery and is now becoming increasingly used in foot and ankle surgery; however, the indications and techniques for WALANT in foot and ankle surgery are still being defined. [13][14][15][16][17][18] The purpose of the present report is to describe the surgical technique for performing IONT with the Arthrex (Naples, Florida, US) Nanoscope nano tendoscopy system for the diagnosis and treatment of common peroneal tendon pathologies. Attention is paid to techniques for obtaining adequate local anesthesia and performing in-office peroneal tendoscopy, indications, and the advantages of performing these procedures in the office rather than the operating room (Video 1).…”

mentioning

confidence: 99%

In-Office Needle Tendoscopy of the Peroneal Tendons

Kanakamedala

Chen

Kaplan

et al. 2022

Arthroscopy Techniques

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In-office needle tendoscopy (IONT) can be used for the diagnosis and treatment of several peroneal tendon pathologies including peroneal tendon tendinopathy, tears, and instability. Benefits of IONT for peroneal tendon disorders include the ability to dynamically evaluate peroneal tendon stability, quicker patient recovery, reduced cost, and improved patient satisfaction. Several studies have suggested that tendoscopic treatment may avoid several complications related to open treatment of peroneal tendon pathologies, including scar formation and groove stenosis. The purpose of the present report is to describe the technique for performing IONT for common peroneal tendon pathologies. This Technical Note describes the techniques for obtaining adequate anesthesia and performing IONT, indications, and advantages of performing these procedures in the office rather than in the operating room.

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“…2 However, many patients report experiencing anxiety during wide-awake hand surgery, as well as during wide-awake foot and ankle surgery. 3,4 Previous nonorthopedic studies have evaluated the effects of music on patient anxiety during a variety of wide-awake medical procedures. Intraprocedural music has been shown to improve patient anxiety during parturition, nasal bone fracture reduction, craniotomies, breast biopsy, transrectal prostate biopsy, extracorporeal shock wave lithotropsy, and colonoscopies.…”

mentioning

confidence: 99%

Noise-Canceling Headphones and Music Decrease Intraoperative Patient Anxiety During Wide-Awake Hand Surgery: A Randomized Controlled Trial

Townsend

Bravo

Jones

et al. 2021

Journal of Hand Surgery Global Online

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Wide-awake local anesthesia no-tourniquet (WALANT) hand surgery has gained popularity because of its cost savings, safety, favorable outcomes, and high patient satisfaction. However, the wideawake nature of the technique causes many patients to experience anxiety during the procedure. Nonorthopedic studies have reported the anxiolytic effects of intraprocedural music in a variety of wideawake medical procedures. This prospective randomized controlled trial investigated the effects of wearing noise-canceling headphones and listening to music on patient anxiety during WALANT hand surgery. Methods: Institutional review board approval was obtained. Patients were randomized to one of the following groups: (1) a headphones group that wore noise-canceling headphones and listened to music (genre of their choice) during the surgery, or (2) a control group that neither wore noise-canceling headphones nor listened to music during surgery. Patient anxiety was assessed on a 10-point visual analog scale before, during, and after surgery. All patients completed an overall experience questionnaire after surgery. Results: Fifty patients were enrolled, with 25 in each group. Both the groups were similar in terms of patient characteristics, diagnosed anxiety, and preoperative level of anxiety. The headphones group was found to have significantly less intraoperative anxiety (1.02 vs 2.32, respectively; P ¼ .017) and a significantly greater net decrease in anxiety from the preoperative to intraoperative level (À1.78 vs À0.56, respectively; P ¼ .033) than the control group. In the headphones group, 92% (23/25) of patients stated that they would recommend wearing noise-canceling headphones and listening to music to other WALANT hand surgery patients. All (50/50) patients in both groups reported that they would choose to undergo WALANT hand surgery again if needed for the same problem. Conclusions: The use of noise-canceling headphones with music during WALANT hand surgery significantly decreases intraoperative patient anxiety. This intervention represents an effective, safe, and inexpensive nonpharmacologic measure to improve patient anxiety and overall experience with WALANT hand surgery. Type of study/level of evidence: Therapeutic I.

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The use of the wide-awake local anesthesia no tourniquet technique in foot and ankle injuries

Cited by 28 publications

References 19 publications

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

In-Office Needle Tendoscopy of the Peroneal Tendons

Noise-Canceling Headphones and Music Decrease Intraoperative Patient Anxiety During Wide-Awake Hand Surgery: A Randomized Controlled Trial

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