Wide awake local anesthesia no tourniquet (WALANT) versus axillary brachial plexus block for carpal tunnel release in a French public university hospital: Care pathways and operating room costs

Boukebous, Baptiste; Maillot, Cédric; Castel, Louis Charles; Donadio, Julia; Boyer, Patrick; Rousseau, M.-A.

doi:10.1016/j.otsr.2022.103358

Orthopaedics & Traumatology: Surgery & Research

2023

DOI: 10.1016/j.otsr.2022.103358

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Wide awake local anesthesia no tourniquet (WALANT) versus axillary brachial plexus block for carpal tunnel release in a French public university hospital: Care pathways and operating room costs

Baptiste Boukebous

Cédric Maillot

Louis Charles Castel

et al.

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Cited by 7 publications

(1 citation statement)

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“…Fractures of the distal radius are usually treated under general or regional anesthesia with a tourniquet to minimize bleeding and allow for better visualization of the surgical field [ 6 ]. Acute physiologic disturbances induced by anesthesia and surgery can lead to decompensation and complications, such as complex regional pain syndrome, complications of sedation, as well as neurological or cardiological complications in elderly patients with extensive chronic disease.…”

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confidence: 99%

Wrist Hemiarthroplasty of Irreparable Distal Radius Fracture under Wide-Awake Local Anesthetic and No Tourniquet

Apard¹,

Odoemene

Descamps

2022

Life

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Distal radius fractures (DRF) are common in elderly patients and the incidence continues to increase with the aging of the population. For irreparable fractures in the elderly, treatment with a reduction cast leads to unreliable results and frequent complications when treated with an anterior plate. Recent studies on hemiarthroplasty for elderly complex wrist fractures have resulted in good clinical and radiologic outcomes, as well as high satisfaction rates. Incorporating wide-awake local anesthesia and no tourniquet (WALANT) in surgical management is beneficial in DRF plating. This technique has not been performed in wrist hemiarthroplasty for an irreparable fracture in an elderly osteoporotic woman. This article describes the WALANT procedure for wrist hemiarthroplasty in a single case, with a detailed description of the technique.

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confidence: 99%

Wrist Hemiarthroplasty of Irreparable Distal Radius Fracture under Wide-Awake Local Anesthetic and No Tourniquet

Apard¹,

Odoemene

Descamps

2022

Life

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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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Wide Awake Scapholunate ligament reconstruction

Apard,

Brutus,

Ahmad

2024

Journal of Orthopaedic Reports

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Wide awake local anesthesia no tourniquet (WALANT) versus axillary brachial plexus block for carpal tunnel release in a French public university hospital: Care pathways and operating room costs

Cited by 7 publications

References 27 publications

Wrist Hemiarthroplasty of Irreparable Distal Radius Fracture under Wide-Awake Local Anesthetic and No Tourniquet

Wrist Hemiarthroplasty of Irreparable Distal Radius Fracture under Wide-Awake Local Anesthetic and No Tourniquet

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

Wide Awake Scapholunate ligament reconstruction

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