Treatment of hand infections using WALANT -when the anesthesiologist is not available: A retrospective cohort study

Enechukwu, Anieto Onochie Matthias; Bucher, Florian; Dastagir, Khaled; Jokuszies, Andreas; Vogt, Peter M.; Könneker, Sören

doi:10.1016/j.amsu.2021.102993

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…We recommend not treating complex extra-articular or intra-articular fractures using the WALANT technique. In areas needing more specialized anesthesiologists and financial resources for GA, the WALANT method allows the surgeon to perform the surgery independently at a lower cost [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study

Chen,

Chou,

Huang

et al. 2023

J Orthop Surg Res

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Background Distal radius fractures (DRF) are frequently treated with internal fixation under general anesthesia or a brachial plexus block. Recently, the wide-awake local anesthesia with no tourniquet (WALANT) technique has been suggested as a method that results in higher patient satisfaction. This study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and balanced anesthesia (BA). Methods Ninety-three patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received BA, comprised of multimodal pain control brachial plexus anesthesia with light general support. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0–10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals and mean ± standard deviation. Results The mean age of patients in the WALANT group was higher than in the BA group (63 ± 17 vs. 54 ± 17, P = 0.005), and there were fewer intra-articular DRF fractures in the WALANT group than in the BA group (AO type A/B/C: 30/3/5 vs. 26/10/19, P = 0.009). The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; − 8.0% [ − 15.7 to − 0.2%]) and 6-month pronation (92% vs. 100%; − 9.1% [ − 17.0 to − 1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0–22.1%]). The overall satisfaction was comparable in the WALANT and BA groups (8.7 vs. 8.5; 0.2 [ − 0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7 ± 2.0, an intraoperative pain scale of 1.2 ± 1.9, and an intraoperative anxiety scale of 2.3 ± 2.8. Conclusion The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and BA groups. With meticulous preoperative planning, the WALANT technique could be an alternative for DRF plating surgery in selected patients. Trial registration This retrospective study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20210201).

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Section: Discussionmentioning

confidence: 99%

Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study

Chen,

Chou,

Huang

et al. 2023

J Orthop Surg Res

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show abstract

“…We recommend not treating complex extraarticular or intra-articular fractures using the WALANT technique. In areas needing more specialized anesthesiologists and nancial resources for GA, the WALANT method allows the surgeon to perform the surgery independently at a lower cost [21].…”

Section: Discussionmentioning

confidence: 99%

Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and general anesthesia: a retrospective cohort study

Chen

Chou

Huang

et al. 2023

Preprint

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Background Distal radius fractures (DRF) are frequently treated with internal fixation under general anesthesia (GA) or a brachial plexus block. Recently, the wide-awake local anesthesia with no tourniquet (WALANT) technique has been suggested as a method that results in higher patient satisfaction. This study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and GA methods. Methods Ninety-three patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received GA. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0 to 10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals (CIs). Results The mean age of patients in the WALANT group was higher than in the GA group (63 ± 17 vs. 54 ± 17, P < 0.01), and there were fewer intra-articular DRF fractures in the WALANT group than in the GA group (AO type A/B/C: 30/3/5 vs. 16/10/19, P < 0.01). The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; -8.0% [-15.7 to -0.2%]) and 6-month pronation (92% vs. 100%; -9.1% [-17.0 to -1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0 to 22.1%]). The overall satisfaction was comparable in the WALANT and GA groups (8.7 vs. 8.5; 0.2 [-0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7 ± 2.0, an intraoperative pain scale of 1.2 ± 1.9, and an intraoperative anxiety scale of 2.3 ± 2.8. Conclusion The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and GA groups. With meticulous preoperative planning, the WALANT technique could be an alternative to GA for DRF plating surgery in selected patients.

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“…Shared decision-making of surgeons and patients remains the basis of successful treatment (45). Infection surgery is no longer considered a relative contraindication (46,47,48).…”

Section: Contraindicationsmentioning

confidence: 99%

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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Treatment of hand infections using WALANT -when the anesthesiologist is not available: A retrospective cohort study

Cited by 6 publications

References 26 publications

Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study

Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study

Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and general anesthesia: a retrospective cohort study

WALANT surgery of the hand: state of the art

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