Arthroplastie trapézo-métacarpienne (TMC) sous Wide Awake Local Anesthesia with No Tourniquet (WALANT) versus ALR: résultat sur la douleur péri et post-opératoire et le résultat fonctionnel précoce, à propos de 30 cas.

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.

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Wide Awake Local Anesthesia No Tourniquet Technique for Extensor Indicis Proprius Tendon Transfer

Archives of Hand and Microsurgery ◽

10.12790/ahm.2017.22.4.233 ◽

2017 ◽

Vol 22 (4) ◽

pp. 233 ◽

Cited By ~ 1

Author(s):

Seungbum Chae ◽

Jae-jung Kim

Keyword(s):

Local Anesthesia ◽

Tendon Transfer ◽

Extensor Indicis Proprius ◽

Wide Awake ◽

No Tourniquet

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

Hand Clinics ◽

10.1016/j.hcl.2018.08.005 ◽

2019 ◽

Vol 35 (1) ◽

pp. 51-58 ◽

Cited By ~ 3

Author(s):

Pedro José Pires Neto ◽

Samuel Ribak ◽

Trajano Sardenberg

Keyword(s):

South America ◽

Local Anesthesia ◽

Hand Surgery ◽

Wide Awake ◽

No Tourniquet

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A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2020.03.013 ◽

2020 ◽

Vol 106 (8) ◽

pp. 1645-1651

Author(s):

Sang Ki Lee ◽

Sung Gul Kim ◽

Won Sik Choy

Keyword(s):

Randomized Controlled Trial ◽

Local Anesthesia ◽

Controlled Trial ◽

Randomized Controlled ◽

Wide Awake ◽

No Tourniquet

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

Journal of Hand Surgery Global Online ◽

10.1016/j.jhsg.2020.09.003 ◽

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

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

British Journal of Surgery ◽

10.1093/bjs/znab202.055 ◽

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.

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