Internal fixation of metacarpal fractures using wide awake local anesthesia and no tourniquet

2020 ◽  
Vol 39 (3) ◽  
pp. 214-217 ◽  
Author(s):  
G. Feldman ◽  
H. Orbach ◽  
B. Rinat ◽  
N. Rozen ◽  
G. Rubin
Keyword(s):  
Internal Fixation ◽  
Local Anesthesia ◽  
Metacarpal Fractures ◽  
Wide Awake ◽  
No Tourniquet

scholarly journals Open reduction and internal fixation of intra-articular distal radius fractures under wide-awake local anesthesia with no tourniquet

2018 ◽  
Vol 46 (10) ◽  
pp. 4269-4276 ◽  
Author(s):  
Hagay Orbach ◽  
Nimrod Rozen ◽  
Guy Rubin
Keyword(s):  
Internal Fixation ◽  
Local Anesthesia ◽  
Distal Radius ◽  
Open Reduction ◽  
Distal Radius Fractures ◽  
Minor Trauma ◽  
Radius Fractures ◽  
Fracture Management ◽  
Wide Awake ◽  
No Tourniquet

Objective The use of wide-awake local anesthesia with no tourniquet (WALANT) is becoming an excellent alternative for elective hand surgeries and hand surgeries involving minor trauma. Although the use of WALANT for some soft tissue surgeries has become the state of the art, data regarding bony procedures, such as fracture management, under WALANT are limited. This study was performed to assess the WALANT technique for open reduction and internal fixation of distal radius fractures. Methods Five patients with displaced distal radius fractures were enrolled in the study. WALANT was carried out about 30 minutes prior to the first incision. Surgery was performed in the normal fashion, and the fractures were fixed using anatomic locking plates. After surgery, the patients were admitted overnight for observation and pain assessment, and they were discharged within 24 hours postoperatively. Intraoperative and postoperative complications were recorded. Follow-up was performed in our outpatient clinic. No abnormalities were recorded. Results All patients underwent a successful painless surgery. No extra bleeding or other complications were recorded. Conclusion The WALANT technique offers a simple and safe alternative to traditional anesthetic techniques for open reduction and plating of distal radius fractures.

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Ian Wellington ◽  
Antonio Cusano ◽  
Joel V. Ferreira ◽  
Anthony Parrino
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Postanesthesia Care Unit ◽  
Complication Rates ◽  
Endoscopic Carpal Tunnel Release ◽  
Average Operating ◽  
Wide Awake ◽  
No Tourniquet ◽  
Room Time

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

Wide Awake Hand Surgery Under Local Anesthesia No Tourniquet in South America

Hand Clinics ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Pedro José Pires Neto ◽  
Samuel Ribak ◽  
Trajano Sardenberg
Keyword(s):  
South America ◽  
Local Anesthesia ◽  
Hand Surgery ◽  
Wide Awake ◽  
No Tourniquet

scholarly journals Plating Distal Radius Fractures Using Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus General Anesthesia: A Cohort Study

2020 ◽  
Vol 2 (6) ◽  
pp. 331-338
Author(s):  
Liew Mei Yi ◽  
Amir Adham Ahmad ◽  
Shairil Rahayu Ruslan ◽  
Shalimar Abdullah ◽  
Abdul Rauf Ahmad
Keyword(s):  
Cohort Study ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Wide Awake ◽  
No Tourniquet

scholarly journals Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
M Cardell ◽  
F Jung ◽  
N Zechmann-Müller ◽  
M Greminger ◽  
L Kern ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Surgical Procedures ◽  
Flexor Tendon ◽  
Hand Surgery ◽  
Patient Comfort ◽  
Injection Pain ◽  
Tendon Transfers ◽  
Fracture Stabilization ◽  
Wide Awake ◽  
No Tourniquet

Abstract Objective Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery. Methods A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger. Results In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself. Conclusion The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain. Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

Impact of Wide-Awake Local Anesthesia No Tourniquet on Departmental Settings, Cost, Patient and Surgeon Satisfaction, and Beyond

Hand Clinics ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Jin Bo Tang ◽  
Shu Guo Xing ◽  
Egemen Ayhan ◽  
Sebastian Hediger ◽  
Simon Huang
Keyword(s):  
Local Anesthesia ◽  
Wide Awake ◽  
No Tourniquet ◽  
Surgeon Satisfaction
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