Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

McKnight, Kelly N.; Smith, Vanessa J.S.; MacFadden, Lisa N.; Chong, Alex C.M.; Demark, Robert E. Van

doi:10.1016/j.jhsg.2022.05.008

Cited by 7 publications

(6 citation statements)

References 47 publications

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“…In addition, carpal tunnel release (CTR) is regularly performed through wide awake anesthesia [ 9 ]. McKnight et al recently reported WALANT outcomes in 1011 elective hand cases, showing safety, low infection rates, cost effectiveness and high patient satisfaction [ 10 ]. However, skin grafting and flap harvesting under WALANT, although being a feasible procedure, has had limited application so far [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case–Control Study

Seretis

Boptsi

et al. 2023

Life

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Background: The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery operations performed on the upper limbs. Methods: Patients who underwent those operations under WALANT were matched and compared with patients who had general or regional anesthesia without infiltration of a local anesthetic solution. All operations were performed by the same surgeon. Data from 98 operations were collected and analyzed for the total operation time, operation theatre time and complication and patient satisfaction rates. Results: All operations under WALANT, mainly skin tumor excision and flap repair or skin grafting and burn escharectomy with or without skin grafting, were completed successfully. No statistical difference in total operation time and complication rates was revealed. Statistical significance favoring WALANT was identified regarding the mean operation theatre time and patient satisfaction. Conclusions: WALANT is an effective method for common plastic surgery operations performed on the upper limbs that is associated with better operation theatre occupancy and high patient satisfaction rates.

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Section: Introductionmentioning

confidence: 99%

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case–Control Study

Seretis

Boptsi

et al. 2023

Life

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“…The hand surgeon should continue to be attentive to techniques that improve the patient experience while preserving hospital resources. 4 , 6 …”

Section: Discussionmentioning

confidence: 99%

“… 4 , 5 By implementing WALANT into hand surgery practices during the pandemic, some institutions have been able to recover from backed-up caseloads and improve resource utilization. 6 As institutions report their experiences with WALANT, no studies to our knowledge have compared their hospital- and clinic-based case volumes before, during, and after the pandemic. By analyzing hand surgery numbers in comparison to both total joint arthroplasty and general surgery case volumes from a single institution, we were able to self-examine our response to the COVID-19 pandemic.…”

mentioning

confidence: 99%

Wide-Awake Surgery and Coronavirus Disease 2019: A Rural Experience

Van Demark,

Hollinsworth

2024

Journal of Hand Surgery Global Online

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“…Although minor hand surgeries are being performed in office-based procedure rooms with increasing frequency 84 , this surgical site is still relatively underutilized 5,34 , primarily because surgeons are reimbursed more to perform procedures in the more costly main operating room 85 . Thus, surgeons must negotiate with payors beforehand to guarantee reasonable reimbursement for services rendered in office-based procedures.…”

Section: Institutional Barriers To Wide-awake Anesthesiamentioning

confidence: 99%

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

2023

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» Wide-awake local anesthesia no tourniquet (WALANT) technique featuring tumescent infiltration of lidocaine with epinephrine at the operative site has broad application in hand surgery including both soft-tissue and bone procedures.» The advantages of wide-awake anesthesia include high patient satisfaction, preserved intraoperative finger and wrist motion, cost-effectiveness, improved operating room efficiency, fewer opioids during recovery, and improved access to hand surgery, which may be performed in an office-based setting without the need for anesthesia personnel.» In properly selected patients, use of lidocaine with epinephrine in the hand and fingers is safe. Rare postprocedure digital ischemia may be effectively treated with phentolamine rescue.» Barriers to adopting wide-awake anesthesia may be overcome by educating resistant stakeholders, including hospital administrators, nurse leaders, and anesthesia colleagues, about the advantages of the WALANT method.» The risk of postoperative complications after hand procedures may be mitigated by using the wide-awake technique instead of regional anesthesia with sedation or general anesthesia.

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Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

Cited by 7 publications

References 47 publications

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case–Control Study

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case–Control Study

Wide-Awake Surgery and Coronavirus Disease 2019: A Rural Experience

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

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