Wide-Awake Anesthesia in the In-Office Procedure Room: Lessons Learned

Demark, Robert E. Van; Becker, Hillary A.; Anderson, Matthew; Smith, Vanessa J.S.

doi:10.1177/1558944717715120

Cited by 42 publications

(42 citation statements)

References 23 publications

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“… 46 The WALANT technique has demonstrated favorable cost savings through improved patient satisfaction, avoiding costly preoperative testing requirements, decreased operative times, reduced utilization of hospital resources and staff, and time spent in the hospital. 15 , 21 Generally, patients undergoing wide-awake procedures are not required to obtain preoperative evaluation and testing for anesthesia clearance. As such, the costs associated with standardized preoperative laboratory tests, medical evaluations, and clinic visits are avoided.…”

Section: Cost Benefitsmentioning

confidence: 99%

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: Cost Benefitsmentioning

confidence: 99%

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

Kurtzman

Etcheson

Koehler

2021

Plastic and Reconstructive Surgery - Global Open

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“… 25 , 26 In addition to reducing facility and material use, wide-awake-local-anesthesia-no-tourniquet (WALANT) and field-sterility surgery is substantially cheaper, especially when performed outside a traditional operating room. 27 , 28 This is perhaps most appropriate technique for hand surgery, but safe, effective minimalism is applicable elsewhere.…”

Section: Resultsmentioning

confidence: 99%

Four Ways Plastic Surgeons Can Fight Climate Change

Brown

Meals

2020

Plastic and Reconstructive Surgery - Global Open

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Background: The climate crisis demands that surgeons reduce their environmental impact. Operating rooms are resource-intensive and are often wasteful. This makes them fitting targets for climate-conscious decision making. Methods: We searched for peer-reviewed literature describing how plastic surgeons might positively affect the environment through action in the operating room. Results: Several evidence-based, pro-climate practices may be undertaken by plastic surgeons. These strategies may be grouped into 4 types: material, energy, technique, and dissemination. Each strategy is a way to reduce, reuse, recycle, research, or rethink. Conclusions: Administrative obstacles to greener operating rooms are predictable and surmountable, especially because environmentally minded decisions are likely to save money. We anticipate a surge of environmental consciousness in healthcare. Plastic surgeons, as thought leaders, are well positioned to champion this cause.

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“…Based on studies applying WALANT for hand and wrist surgery, it is known that patients operated on with the WALANT technique score high on patient satisfaction (reviewed in van Demark RE et al 29 ), with many (86%) saying they would choose the same technique again and 90% saying they would recommend it to a friend. 30 In our study, around 96% (n = 53) of the WALANT group said they would undergo the same procedure again if needed, as opposed to 83.9% (n = 47) and 86.2% (n = 50) for the general anaesthesia and Bier’s block groups.…”

Section: Discussionmentioning

confidence: 99%

Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique

Tahir

Chaudhry

Zaffar

et al. 2020

Bone & Joint Research

101

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Aims We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue. Methods This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier’s block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant. Results Operations with WALANT proceeded sooner, and patients recovered faster, resulting in mean fewer missed working days (7.8 (SD 1.67)) compared with general anaesthesia (20.1 (SD 7.37)) or Bier’s block (14.1 (SD 7.65)) (p < 0.001). The WALANT patients did not develop complications, while the other patients did (p < 0.04). Clinical outcomes did not differ, nor did surgeon qualification affect clinical outcomes. Mean hospital costs were lower for WALANT ($428.50 (SD 77.71)) than for general anaesthesia ($630.63 (SD 114.77)) or Bier’s block ($734.00 (SD 37.54)) (p < 0.001). Patient satisfaction was also higher (p < 0.001). Conclusion WALANT for distal radius fractures results in a faster recovery, is more cost-effective, has similar clinical outcomes, and has fewer complications than general anaesthesia or Bier's block. This makes WALANT an attractive technique in any setting, but especially in middle- and low-income countries. Cite this article: Bone Joint Res 2020;9(7):429–439.

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Wide-Awake Anesthesia in the In-Office Procedure Room: Lessons Learned

Abstract: The concurrent use of WALANT and minor field sterility has created a hand surgery practice that is cost-effective for the patient and the facility and resulted in excellent patient outcomes and satisfaction.

Cited by 42 publications

References 23 publications

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

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

Four Ways Plastic Surgeons Can Fight Climate Change

Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique

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