The Impact of Intraoperative Nursing Care on Perioperative Complications During Wide-Awake Local Anesthesia Hand Surgery

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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Epinephrine in Local Anesthesia in Finger and Hand Surgery: The Case for Wide-awake Anesthesia

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-21-08-443 ◽

2013 ◽

Vol 21 (8) ◽

pp. 443-447 ◽

Cited By ~ 86

Author(s):

D. Lalonde ◽

A. Martin

Keyword(s):

Local Anesthesia ◽

Hand Surgery ◽

Wide Awake

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The Current and Possible Future Role of Wide-Awake Local Anesthesia No Tourniquet Hand Surgery in Military Health Care Delivery

Hand Clinics ◽

10.1016/j.hcl.2018.08.008 ◽

2019 ◽

Vol 35 (1) ◽

pp. 13-19 ◽

Cited By ~ 3

Author(s):

Peter Charles Rhee

Keyword(s):

Health Care ◽

Local Anesthesia ◽

Health Care Delivery ◽

Care Delivery ◽

Hand Surgery ◽

Military Health ◽

Military Health Care ◽

Wide Awake ◽

No Tourniquet

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Effectiveness and Safety of Wide Awake Local Anesthesia no Tourniquet (WALANT) Technique in Hand Surgery

Revista de Chimie ◽

10.37358/rc.19.10.3587 ◽

2019 ◽

Vol 70 (10) ◽

pp. 3587-3591

Keyword(s):

Hospital Stay ◽

Correlation Coefficient ◽

Local Anesthesia ◽

Length Of Hospital Stay ◽

Hand Surgery ◽

Patient Comfort ◽

Tunnel Syndrome ◽

Positive Direct ◽

Wide Awake ◽

No Tourniquet

The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. The study group consisted of 120 patients in which local anesthesia with 1% lidocaine and 1: 100,000 epinephrine solution was used. The conditions requiring surgery were Dupuytren disease (DD) stages II and III affecting one or two digital rays, carpal tunnel syndrome (CTS), trigger finger (TF), rupture of the flexor pollicis longus (FPL) tendon. The amount of anesthetic used, onset time, intraoperative bleeding, surgeon’s comfort during surgery, patient’s comfort, operative time, the immediate postoperative complications and length of hospital stay were evaluated, correlations between these parameters being made with the help of SPSS 20.0 software using regressions (ANOVA), and taking into account Pearson correlation coefficients with statistical significance, alpha at most .05 and CI 95%. In the group of 120 operated patients (58 men - M and 62 female -F) (M/F ratio = 0.93), no cases of digital necrosis or other vascular complications were recorded. Also, the absence of tourniquets did not result in intraoperative bleeding causing discomfort to the surgeon. The amount of anesthetic varied, being less than that recommended in the literature in approximately 40% of the cases. In all cases, patient comfort and satisfaction were highest, and length of hospital stay was several hours. Phentolamine, an antidote used to reverse the effects of epinephrine, was not used in any case. The correlation coefficient between the amount of anesthetic and waiting time = 0.3372 (p = 0.0001) - positive, direct, moderate, and statistically significant correlation. The correlation coefficient between the amount of anesthetic and length of hospital stay = 0.2700 (p = 0.002) - positive, direct, weak and statistically significant correlation. Correlation coefficient between age and length of hospital stay = 0.1361 (p = 0.1380) - positive, direct, weak correlation, but statistically insignificant. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal. Keywords: local anesthesia, epinephrine, Dupuytren disease (DD), carpal tunnel syndrome (CTS), trigger finger (TF)

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The Safety of Wide-Awake, Local Anesthesia, No Tourniquet Hand Surgery: Two Cases of Digital Ischemia

Plastic & Reconstructive Surgery Global Open ◽

10.1097/01.gox.0000720788.44602.55 ◽

2020 ◽

Vol 8 (9S) ◽

pp. 94-95

Author(s):

Julia Anne Cook ◽

Daniel P. Donato ◽

Jeffrey N. Gross ◽

Patrick A. Gerety ◽

Sarah E. Sasor

Keyword(s):

Local Anesthesia ◽

Hand Surgery ◽

Digital Ischemia ◽

Wide Awake ◽

No Tourniquet

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Transient Tourniquet and Electro-cauterization applied for Surgery in Metacarpal Fractures Under Local Anesthesia with Epinephrine

10.21203/rs.3.rs-816248/v1 ◽

2021 ◽

Author(s):

Ren-Guo XIE

Keyword(s):

Local Anesthesia ◽

Surgical Outcome ◽

Operative Time ◽

Hand Surgery ◽

Tourniquet Time ◽

Anatomical Structures ◽

Metacarpal Fractures ◽

Surgical Field ◽

Wide Awake

Abstract Background : The purpose of this study is to illustrate whether the electro-cauterization and transient tourniquet enhanced efficiency of local anesthesia with epinephrine in surgery of metacarpal fractures. Methods : Forty-four consecutive cases of metacarpal fractures with estimated major operative time more than 30 minutes were enrolled. Local anesthesia with epinephrine, electro-cauterization and transient tourniquet were performed. Data regarding anesthesia effect, bleeding in the surgical field (with inflating and deflating tourniquet), time when patient felt uncomfortable with tourniquet, inspection of the surgical outcome, and some other surgical tricks were collected and evaluated. Results : All patients felt no pain for whole surgical period in the surgical field. Time when patient felt uncomfortable with tourniquet was about 16 minutes. Mean tourniquet time was about 29 minutes. There was no or less bleeding in the surgical field for whole surgical period. The anatomical structures, such as nerve, tendon and vessel can be easily distinguished and dissected. Outcome of repair and reconstruction could be examined with instructed movement. Postoperative inspection showed no symptom of inflammation. Conclusions : Local anesthesia with epinephrine, electro-cauterization and transient tourniquet for major hand surgery can save time and obtain wide-awake effect, which would satisfy both doctors and patients.

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