WALANT Special Issue
Safety of Lidocaine During Wide-Awake Local Anesthesia No Tourniquet for Distal Radius PlatingThis study evaluated the clinical and biochemical safety profile of infiltration of lidocaine with adrenaline in wide-awake local anesthesia no tourniquet for distal radius plating.
Impact of WALANT Hand Surgery in a Secondary Care Hospital in Spain. Benefits to the Patient and the Health SystemThe aim of this study is to compare patient benefits and economic costs of hand surgeries using the wide-awake local anesthesia no tourniquet (WALANT) technique versus a conventional major outpatient suite and review outcomes and complications in a series of cases of patients operated on using the WALANT technique.
Wide-Awake Hand Surgery Experience in Patients 10 to 18 Years of AgeWe investigated the frequency of wide-awake local anesthesia no tourniquet (WALANT) use for hand surgery in the a 10- to 18-year–old age group and patients’ experiences.
WALANT: Past, Present and the FutureIn the last decade, WALANT (Wide-awake Local Anaesthesia No Tourniquet) surgery has been widely utilized globally with an exponential increase in publications.1,2 Yet, the myth of adrenaline causing finger ischaemia is still strong and prevalent despite numerous publications. It is only in hand and microsurgery and perhaps in orthopaedic and plastic surgery where WALANT predominates otherwise in other areas of medicine, the taboo is still strong.
The Brazilian Perspective of WALANT in Fracture Fixation From the Hand to the ElbowThe wide-awake local anesthesia no tourniquet (WALANT) technique is currently being used by several hand surgeons. This technique enables surgeries to be performed with the patient fully awake and without a tourniquet, thus allowing the intraoperative assessment of function. The purpose of this article was to describe our WALANT techniques for metacarpal, scaphoid, distal radius, radial head, and olecranon fracture fixation with its pearls and pitfalls. The authors demonstrate their infiltration technique, detailing how to perform it using lidocaine with 1:100,000 epinephrine and 8.4% sodium bicarbonate.
Procedural Technique for Wide Awake Local Anesthesia No Tourniquet Injection for Endoscopic Carpal Tunnel ReleaseCarpal tunnel syndrome is the most common upper extremity peripheral neuropathy syndrome. Treatment ranges from nonsurgical methods, including night-orthosis fabrication and corticosteroid injections to surgical management via a carpal tunnel release (CTR). Carpal tunnel release alleviates nerve compression by releasing the transverse carpal ligament, and performed as either an open CTR (OCTR) or endoscopic CTR (ECTR) procedure. However, there is no consensus on the superiority of the 2 approaches.
Wide-Awake Local Anesthesia, No Tourniquet Surgery in the PhilippinesThe use of wide-awake local anesthesia, no tourniquet (WALANT) has been adapted by most hand surgeons in the Philippines. This is especially true for centers with a large volume of patients needing specialized care for the hand. The use of WALANT has enabled surgeons to do procedures on an outpatient basis, thus potentially creating cost-saving measures for patients and health care facilities. Aside from common outpatient procedures like carpal tunnel syndrome, trigger finger, and de Quervain tenosynovitis, open reduction internal fixation of hand fractures, acute tendon repairs, tendon transfers, and reconstructions have been performed under WALANT as outpatient procedures.
Intraoperative Active Motion Confirmation During Wide-Awake Local Anesthesia No Tourniquet SurgeryAs a recent advance in the field of hand surgery, the wide-awake local anesthesia no tourniquet surgical technique—performed using an epinephrine-containing local anesthetic without a tourniquet while the patient is awake—has attracted attention. The wide-awake local anesthesia no tourniquet technique has been indicated for surgeries such as trigger release, soft tissue tumor excision, surgery for Dupuytren contracture, thumb carpometacarpal arthroplasty, or any other tendon, nerve, or ligament surgeries, requiring intraoperative active motion confirmation.
Prospective Evaluation of Pain and Anxiety Levels Between Wide-Awake Local Anesthesia No Tourniquet and General Anesthesia With Tourniquet in Excision of Wrist GanglionsExcision of wrist ganglions is a common procedure in hand surgery. Our objective was to determine whether the type of anesthesia (general anesthesia [GA] vs wide-awake local anesthesia no tourniquet [WALANT] technique) would affect patient satisfaction regarding intraoperative pain control, postoperative pain management, and anxiety.
Novel Use of the Wide-Awake Local Anesthesia No Tourniquet Technique for Release of Spastic Upper LimbsWide-awake local anesthesia no tourniquet procedures allow the patient to remain conscious and cooperative during surgery, allowing intraoperative assessments of hand function. This is useful in spastic hand surgeries, allowing an instant assessment of the muscle releases and residual power, thus guiding an optimal balance with the best possible functional outcomes. We describe the novel use of wide-awake, local anesthesia, no tourniquet surgery in spastic upper-limb surgery in forearm flexor-pronator release, thumb-in-palm and intrinsic-plus deformity correction, and elbow flexor release.
How to Start WALANT Practice in South Africa: “Service With a Smile if You Are Willing to Wait Awhile.”Wide-awake local anesthesia no tourniquet (WALANT) hand surgery at 1 Military Hospital in South Africa resulted in a positive patient experience and beneficial financial outcomes in an economically constrained environment. Using the WALANT technique also effectively reduced the waiting time for elective surgery, which is considered to be synonymous with improvement in the public health sector in South Africa. Elderly patients and those medically unfit for general anesthesia successfully underwent WALANT surgery and returned to daily activities.
Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 PatientsWide-awake local anesthesia with no tourniquet has dramatically changed hand surgery practice. Using lidocaine with epinephrine and no tourniquet has allowed many procedures to be moved from the main operating room to an in-office procedure room. Previous studies have shown that using local anesthesia is safe and cost effective, with high patient satisfaction. This study evaluated patient satisfaction and complications for the first 1,011 elective hand surgeries performed using wide-awake anesthesia in an in-office procedure room.
Economic and Environmental Impacts of the Wide-Awake, Local Anesthesia, No Tourniquet (WALANT) Technique in Hand Surgery: A Review of the LiteratureThe United States spends more on health care than any other country in the world based on the percentage of gross domestic product. This fact is coupled with health care facilities contributing nearly one-tenth of all greenhouse gas emissions in the United States, and with the health care industry’s waste contributions to landfills being second only to those of the food industry. In some instances, operating rooms produce the majority of total landfill waste from hospitals; therefore, patients undergoing surgical procedures can have both financial and environmental impacts.
Pediatric Wide-Awake Local Anesthesia No-Tourniquet Hand Surgery: A Practical ApproachPediatric wide-awake local anesthesia no-tourniquet technique (WALANT) hand surgery is feasible for the treatment of the spectrum of pediatric hand surgeries, which can include traumatic injuries and congenital hand differences. The key component for success is identifying the appropriate patient for this technique, with the typical patient frequently being >10 years of age. The discussion with the patient and adequate preparation for maximum efficiency become key for patient and surgeon comfort.
Successful Boutonniere Reconstruction With Wide-Awake Local Anesthesia No TourniquetIn this retrospective study, we evaluated the results of central slip reconstruction with a modified Snow’s technique under wide-awake local anesthesia no tourniquet.
Effective Things Surgeons Can Tell Patients During Wide-Awake Local Anesthesia No Tourniquet Surgery to Decrease Complications and Improve OutcomesSurgeons are familiar with surgical technique articles that provide step-by-step details of various surgical procedures relevant to clinical practice. This article is a communications technique article that provides step-by-step things that a surgeon can say to a wide-awake patient during the surgery to improve outcomes in clinical practice. The absence of anamnestic sedation enables memorable patient education from their surgeon to decrease the risk of postoperative complications.
Usefulness of Wide-Awake Local Anesthesia No Tourniquet Surgery to Decide on Tendon Transfer Versus Grafting in Chronic Flexor Tendon RuptureWe investigated the clinical outcomes of flexor tendon reconstruction for chronic rupture of the flexor tendon based on an evaluation of the voluntary active contraction distance (ACD) of the ruptured musculotendinous unit and changes in intraoperative total active motion (TAM) that could only be observed during wide-awake local anesthesia no tourniquet (WALANT) surgery.
Technique of Wide-Awake Local Anesthesia No Tourniquet Injection for a Transradial Forearm Amputation in an Ischemic HandA 48-year-old man with drug addiction presented with gangrene of the right hand following an inadvertent intra-arterial administration of crushed dihydrocodeine tartrate (DF 118) tablets (GlaxoSmithKline S.A.) dissolved in water; the solution was injected into his right antecubital fossa. After 3 weeks of pain, paresthesia, and cyanosis, his right hand became gangrenous. We performed a right forearm amputation by use of the wide-awake local anesthesia no tourniquet technique. After surgery, his wound healed well, and he was successfully fitted with a hand prosthesis.
Triggering Thumb Is Not Always a Trigger ThumbAlthough rare, the thumb can trigger because of de Quervain disease. An 18-year-old woman presented with painful triggering during thumb movements. Physical examination revealed locking upon thumb extension and painful snapping upon thumb flexion, with tenderness over the first extensor compartment. During the ultrasonography examination, the extensor pollicis brevis tendon snapped with a jerky movement. According to intraoperative active movement under wide-awake local anesthesia no tourniquet, only the extensor pollicis brevis tendon subcompartment was released, and the snapping was resolved.
Application of WALANT in Diaphyseal Plating of Forearm Fractures: An Observational StudyWide-Awake Local Anesthesia No Tourniquet (WALANT) is a novel anesthesia technique in distal radius and ankle fracture fixation. However, to date, there are limited studies in diaphyseal plating of forearm fractures under WALANT. This research is to study the feasibility of the use of WALANT technique in plating of diaphyseal fractures of the forearm as well as peri-operative outcomes.
Current Evidence Involving WALANT SurgeryWide-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.
The Impact of Intraoperative Nursing Care on Perioperative Complications During Wide-Awake Local Anesthesia Hand SurgeryThe wide-awake local anesthesia technique in hand surgery is widely used, but there are currently no guidelines or protocols for the number of operating room personnel required to optimize patient safety intraoperatively. This study aimed to evaluate perioperative complication rates of wide-awake local anesthesia hand surgeries performed at surgery centers that used different numbers of operating room nurses.