Current Evidence Involving WALANT Surgery

Katherine M Connors, Sara M Guerra, Steven M Koehler, Katherine M Connors, Sara M Guerra, Steven M Koehler

Abstract

Wide-awake local anesthesia no-tourniquet (WALANT) surgery is an attractive option for hand surgeons, particularly during resource-scarce periods, as it eliminates dependence on main operating rooms or hospital-based procedures. The limited prepping or draping used for WALANT field sterility is as effective, if not more effective, than standard sterile prepping or draping. Patient anxiety surrounding WALANT surgery is similar to or less than that of general or local anesthesia with or without tourniquet. Patients use the same or lower amounts of postoperative narcotics after WALANT as compared to after the other anesthetic methods. Wide-awake local anesthesia no-tourniquet surgery saves significant costs for the same surgeries when performed under general or local anesthesia with or without tourniquet. There are very few complications associated with the WALANT method of anesthesia; rare case reports include vasovagal syncope and cardiac arrhythmia due to inadvertent intravascular injection of epinephrine.

Keywords: Field sterility; Lidocaine with epinepherine; Local anesthesia; WALANT; WALEvidence; Wide-awakeANT.

© 2022 The Authors.

References

    1. Wellington I, Cusano A, Ferreira JV, Parrino A. WALANT technique versus sedation for endoscopic carpal tunnel release. Hand (N Y). Published online April 9, 2021.
    1. Huang Y.C., Hsu C.J., Renn J.H., et al. WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet. J Orthop Surg Res. 2018;13(1):195.
    1. Tahir M., Chaudhry E.A., Zaffar Z., et al. Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: a randomized control trial of a cost-effective and resource-friendly procedure. Bone Joint Res. 2020;9(7):429–439.
    1. Moscato L., Laborde A., Kouyoumdjian P., Coulomb R., Mares O. Trapeziometacarpal (TMC) arthroplasty under wide awake local anesthesia with no tourniquet (WALANT) versus local anesthesia with peripheral nerve blocks (LAPNV): perioperative pain and early functional results in 30 patients. Hand Surg Rehabil. 2021;40(4):453–457.
    1. Arik H.O., Coskun T., Kose O. Management of spaghetti wrist under WALANT technique. Hand Surg Rehabil. 2021;40(5):655–659.
    1. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108(1):114–124.
    1. Lalonde D.H. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol. 2017;42(9):886–895.
    1. Lambert G., Syners J. Gangrene des doights consecutive à l’anesthesie loco-régionale [Finger gangrene following loco-regional anesthesia] Rev Chir. 1933;52:741.
    1. Hanke H. Fingerspitzennekrose nach in Lokalasthesie ausgerfuhrter operation wegen Dupuytren-scher Kontraktur [Fingertip necrosis after surgery performed under local anesthesia for Dupuytren’s contracture] Chirurg. 1936;8:684.
    1. Kaufman P.A. Gangrene following digital nerve block anesthesia: report of a case. Arch Surg. 1941;42(5):929.
    1. Pelner L. Gangrene of the toe following local anesthesia with procaine-epinephrine solution. NY State Meds J. 1942;544:1942.
    1. De Rougemont J., Carcassoone F. L’anesthesie regionale dans la pratique journaliere des interventions au niveau des doigts [Regional anesthesia in the daily practice of finger procedures] Presse Med. 1933;41(218)
    1. Burnham P.J. Regional block anesthesia for surgery of fingers and thumb. Ind Med Surg. 1958;27(2):67–69.
    1. Johnson H.A. Infiltration with epinephrine and local anesthestic mixture in the hand. JAMA. 1967;200(11):990–991.
    1. McGlamry E.D. Management of painful toes from distorted toenails. J Dermatol Surg Oncol. 1979;5(7):554–556.
    1. Earle A.S., Blanchard J.M. Regional anesthesia in the upper extremity. Clin Plast Surg. 1985;12(1):97–114.
    1. Sylaidis P., Logan A. Digital blocks with adrenaline. An old dogma refuted. J Hand Surg Br. 1998;23(1):17–19.
    1. Wilhelmi B.J., Blackwell S.J., Miller J., Mancoll J.S., Phillips L.G. Epinephrine in digital blocks: revisited. Ann Plast Surg. 1998;41(4):410–414.
    1. Leblanc M.R., Lalonde D.H., Thoma A., et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y) 2011;6(1):60–63.
    1. Avoricani A, Dar Q-A, Levy KH, Kurtzman JS, Koehler SM. WALANT hand and upper extremity procedures performed with minor field sterility are associated with low infection rates. Plast Surg. Published online May 6, 2021.
    1. Davison P.G., Cobb T., Lalonde D.H. The patient's perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study. Hand (N Y) 2013;8(1):47–53.
    1. Gunasagaran J., Sean E.S., Shivdas S., Amir S., Ahmad T.S. Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet. J Orthop Surg (Hong Kong) 2017;25(3)
    1. Saleh E., Saleh J., Govshievich A., Ferland-Caron G., Lin J.C., Tremblay D.M. Comparing minor hand procedures performed with or without the use of a tourniquet: a randomized controlled trial. Plast Reconstr Surg Glob Open. 2021;9(4)
    1. Abd Hamid M.H., Abdullah S., Ahmad A.A., et al. A randomized controlled trial comparing wide-awake local anesthesia with no tourniquet (WALANT) to general anesthesia in plating of distal radius fractures with pain and anxiety level perception. Cureus. 2021;13(1)
    1. Dar Q.A., Avoricani A., Rompala A., et al. WALANT hand surgery does not require postoperative opioid pain management. Plast Reconstr Surg. 2021;148(1):121–130.
    1. Chapman T., Kim N., Maltenfort M., Ilyas A.M. Prospective evaluation of opioid consumption following carpal tunnel release surgery. Hand (N Y) 2017;12(1):39–42.
    1. Kang S.W., Park H.M., Park J.K., et al. Open cubital and carpal tunnel release using wide-awake technique: reduction of postoperative pain. J Pain Res. 2019;12:2725–2731.
    1. Ki Lee S., Gul Kim S., Sik Choy W. A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet. Orthop Traumatol Surg Res. 2020;106(8):1645–1651.
    1. Evangelista T.M.P., Pua J.H.C., Evangelista-Huber M.T.P. Wide-awake local anesthesia no tourniquet (WALANT) versus local or intravenous regional anesthesia with tourniquet in atraumatic hand cases in orthopedics: a systematic review and meta-analysis. J Hand Surg Asian Pac Vol. 2019;24(4):469–476.
    1. Rhee P.C., Fischer M.M., Rhee L.S., McMillan H., Johnson A.E. Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures. J Hand Surg Am. 2017;42(3):e139–e147.
    1. Maliha S.G., Cohen O., Jacoby A., Sharma S. A cost and efficiency analysis of the WALANT technique for the management of trigger finger in a procedure room of a major city hospital. Plast Reconstr Surg Glob Open. 2019;7(11)
    1. Codding J.L., Bhat S.B., Ilyas A.M. An economic analysis of MAC versus WALANT: a trigger finger release surgery case study. Hand (N Y) 2017;12(4):348–351.
    1. Reynolds M, Srinivasan RC, Person DW. Complications after clinic-based wide awake local anesthesia no tourniquet hand surgery at a single private practice. Hand (N Y). Published online December 14, 2020.
    1. Avoricani A., Dar Q.A., Levy K.H., Koehler S.M. WALANT hand surgery: do the AORN guidelines apply? J Surg Orthop Adv. 2021;30(3):156–160.
    1. Greene B.H.C., Lalonde D.H., Seal S.K.F. Incidence of the “adrenaline rush” and vasovagal response with local anesthetic injection. Plast Reconstr Surg Glob Open. 2021;9(6):e3659.
    1. Lalonde D.H., Wong A. Dosage of local anesthesia in wide awake hand surgery. J Hand Surg Am. 2013;38(10):2025–2028.
    1. Zhang J.X., Gray J., Lalonde D.H., Carr N. Digital necrosis after lidocaine and epinephrine injection in the flexor tendon sheath without phentolamine rescue. J Hand Surg Am. 2017;42(2):e119–e123.
    1. Abdullah S., Chia Hua L., Sheau Yun L., et al. A review of 1073 cases of wide-awake-local-anaesthesia-no-tourniquet (WALANT) in finger and hand surgeries in an urban hospital in Malaysia. Cureus. 2021;13(7)
    1. Ayhan E., Akaslan F. Patients' perspective on carpal tunnel release with WALANT or intravenous regional anesthesia. Plast Reconstr Surg. 2020;145(5):1197–1203.
    1. Bina B., Hersh E.V., Hilario M., Alvarez K., McLaughlin B. True allergy to amide local anesthetics: a review and case presentation. Anesth Prog. 2018;65(2):119–123.
    1. Thakkar M., Bednarz B. WALANT and sickle cell disease: a cautionary tale. J Plast Reconstr Aesthet Surg. 2021;74(7):1633–1701.
    1. Thomson C.J., Lalonde D.H., Denkler K.A., Feicht A.J. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007;119(1):260–266.
    1. Turcotte J.J., Gelfand J.M., Jones C.M., Jackson R.S. Development of a low-resource operating room and a wide-awake orthopedic surgery program during the COVID-19 pandemic. Surg Innov. 2021;28(2):183–188.
    1. Kurtzman J.S., Etcheson J.I., Koehler S.M. Wide-awake local anesthesia with no tourniquet: an updated review. Plast Reconstr Surg Glob Open. 2021;9(3)
    1. Nolan G.S., Kiely A.L., Madura T., et al. Wide-awake local anaesthesia no tourniquet (WALANT) vs regional or general anaesthesia for flexor tendon repair in adults: protocol for a systematic review and meta-analysis. Syst Rev. 2020;9:264.

Source: PubMed

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