600 The Use of a Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Technique in Foot and Ankle Procedures - A Randomised Control Trial

Abstract Introduction Wide awake local anaesthesia no tourniquet (WALANT) is a widely used technique in upper limb procedures that has gained increasing popularity during the coronavirus pandemic. The benefit of WALANT for foot and ankle surgeries is less clear, especially in patients with multiple comorbities. The primary aim of this study was to compare post-operative pain levels in patients undergoing ankle fracture fixation. Secondary objectives included comparison of intra-operative patient experiences, clinical outcomes, and patient satisfaction 1-year post-procedure. Method 129 patients presenting with ankle fractures were enrolled in a multicenter randomised control trial from February 2016 to January 2020. Patients with medial malleolar, lateral malleolar, bimalleolar or trimalleolar fractures received either WALANT (62 patients) or spinal anaesthesia (67 patients). A 5ml solution of 0.9% saline and 2% lidocaine with 1: 100,000 adrenaline was used for WALANT. Results Compared to patients who received spinal anaesthesia, those in the WALANT group experienced less post-operative discomfort and were more satisfied 1-year post-procedure (p-value = 0.003). Surgical outcomes were similar for both groups. Cost analysis revealed that WALANT is significantly more economical. Conclusions WALANT is an effective and safe anaesthetic for foot and ankle procedures. Without use of a tourniquet, it reduces post-operative pain and so, eases patient recovery.

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Positive patient experience of wide awake local anaesthesia no tourniquet (WALANT) hand surgery in the government setting: a prospective descriptive study

SA Orthopaedic Journal ◽

10.17159/2309-8309/2021/v20n3a1 ◽

2021 ◽

Vol 20 (3) ◽

Author(s):

Jaco J Naude ◽

Odette Koch ◽

Ludwig W Schmidt ◽

Theo LB le Roux

Keyword(s):

Patient Experience ◽

Carpal Tunnel ◽

Local Anaesthesia ◽

Surgical Procedure ◽

Hand Surgery ◽

Descriptive Study ◽

Trigger Finger ◽

The Mean ◽

Wide Awake ◽

No Tourniquet

ABSTRACT BACKGROUND: The purpose of this study was to establish a subjective patient experience with wide awake local anaesthesia no tourniquet (WALANT) procedures performed in the institution from May 2019 to March 2020. WALANT surgery was initiated to improve standard operating procedure and to decrease theatre burden METHODS: This prospective, descriptive study included 100 patients with a mean age of 59 years who required either a carpal tunnel or trigger finger release. The patients' pain experience was documented on the visual analogue scale (VAS) for the local anaesthetic injection and the surgical procedure. Overall experience was assessed on the patient's preference to have the procedure performed by the WALANT method or the conventional method RESULTS: One hundred patients were included, of which 67 had medical comorbidities. The mean VAS score was 1.5 (SD±1.6) with pain on injection. The mean VAS pain score during the surgical procedure was 0.2 (SD±0.7). One hundred per cent of patients (100/100) felt they would do the WALANT outpatient procedure again instead of admission to hospital and surgery in the theatre. Two complications occurred related to wound care problems, and were successfully managed. None of the patients required reoperations for incomplete release of the carpal tunnel or trigger finger surgery CONCLUSION: The results of this study suggest that minor hand surgery using the WALANT protocol can be performed effectively and with high patient satisfaction rates in the orthopaedic outpatient clinic, and is a useful tool in the skillset of a hand surgeon Level of evidence: Level 4 Keywords: WALANT, hand surgery, trigger finger, carpal tunnel release

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Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet

Journal of Orthopaedic Surgery ◽

10.1177/2309499017739499 ◽

2017 ◽

Vol 25 (3) ◽

pp. 230949901773949 ◽

Cited By ~ 10

Author(s):

Jayaletchumi Gunasagaran ◽

Ee Soon Sean ◽

Sachin Shivdas ◽

Shams Amir ◽

Tunku Sara Ahmad

Keyword(s):

Local Anaesthesia ◽

Wide Awake ◽

No Tourniquet

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Effects of barefoot walking on the flat foot in school going children: A Randomised control trial

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4382 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 1805-1812

Author(s):

Sharath Hullumani V ◽

Purusotham Chippala

Keyword(s):

Controlled Trial ◽

Intervention Group ◽

Well Being ◽

Randomised Control Trial ◽

Control Group ◽

P Value ◽

Foot And Ankle ◽

Flat Foot ◽

Study Results ◽

Arch Index

Flat foot is also called Plano-valgus foot, and it is a term, that is commonly used in describing flat foot. Some studies have suggested, that certain foot-specific exercises and barefoot weight bear walking can change foot function like flat foot, and also confirm that shoed walking children are more likely to get a flat foot. An Assessor blinded, Randomized controlled trial with thirty-eight children with flat foot aged 6 – 14 years, both male and female were randomised to the control group (n= 19) and intervention group (n=19). The control group had performed barefoot walking for 45 minutes a day for eight weeks, and the intervention group had received foot-specific exercises with barefoot walking for eight weeks. Foot posture was evaluated by the arch index, while the Oxford foot and ankle questionnaire was used to measure the subjective well-being of children. Measurements were taken before and after the eight weeks of intervention. The outcome of the randomised control trial showed that the barefoot walking group faired far better than that which didn't (p-value <0.05). The intervention group outcomes measure Arch Index, and Oxford Foot and Ankle Questionnaire were p-values is <0.05 from seventh and eight weeks. This study results suggest that barefoot walking and specific foot exercises are effective in improving the flat foot in school-going children.

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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 ◽

10.7759/cureus.16269 ◽

2021 ◽

Author(s):

Shalimar Abdullah ◽

Lim Chia Hua ◽

Lau Sheau Yun ◽

Alexander Samuel Thavamany Devapitchai ◽

Amir Adham Ahmad ◽

...

Keyword(s):

Local Anaesthesia ◽

Urban Hospital ◽

Wide Awake ◽

No Tourniquet

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The use of the wide-awake local anesthesia no tourniquet technique in foot and ankle injuries

Foot and Ankle Surgery ◽

10.1016/j.fas.2020.07.002 ◽

2020 ◽

Author(s):

Yenel Gürkan Bilgetekin ◽

Yakup Kuzucu ◽

Alper Öztürk ◽

Sinan Yüksel ◽

Halis Atıl Atilla ◽

...

Keyword(s):

Local Anesthesia ◽

Ankle Injuries ◽

Foot And Ankle ◽

Wide Awake ◽

No Tourniquet

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Comparison of Wide Awake Local Anaesthesia No Tourniquet Technique with Tourniquet Application under General Anesthesia in Carpal Tunnel Syndrome: A Retrospective Study

European Archives of Medical Research ◽

10.4274/eamr.galenos.2018.68077 ◽

2019 ◽

Vol 35 (4) ◽

pp. 220-223

Author(s):

Mustafa Çağlar Kır ◽

Mehmet Kürşad Bayraktar ◽

Hakan Gürbüz

Keyword(s):

Retrospective Study ◽

Carpal Tunnel Syndrome ◽

General Anesthesia ◽

Carpal Tunnel ◽

Local Anaesthesia ◽

Tunnel Syndrome ◽

Wide Awake ◽

No Tourniquet

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Comparison of intra-articular injection of local anaesthetic Ropivacaine versus Ropivacaine+Ketorolac and Ropivacaine+Tramadol for post-operative pain relief in knee and hip arthroplasty surgeries under spinal anaesthesia

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.040 ◽

2021 ◽

Vol 8 (2) ◽

pp. 199-204

Author(s):

Anita Surana ◽

Vipin Baxi

Keyword(s):

Pain Relief ◽

Spinal Anaesthesia ◽

Hip Arthroplasty ◽

Local Anaesthetic ◽

P Value ◽

Double Blind Study ◽

Rescue Analgesia ◽

Patient Satisfaction Score ◽

Post Operative Pain ◽

Knee And Hip Arthroplasty

Local anaesthetic infiltration in knee and hip arthroplasty is employed as a part of multi-model analgesia to reduce opiate consumption and help in early ambulation of elderly people It reduces post-operative pain effectively and thus reduces complications like Deep vein thrombosis, pulmonary embolism, pneumonia and even myocardial infection. Addition of ketorolac or Tramadol further prolongs the duration of analgesia. To compare the local anaesthetic infiltration of Ropivacaine alone and Ropivacaine with Ketorolac and Ropivacaine with tramadol for postoperative pain relief in knee and hip arthroplasty. Randomize double-blind study was conducted on 60 patients undergoing knee or hip arthroplasty under spinal anaesthesia. Group A patients received wound infiltration with Inj. Ropivacaine0.75% 50ml (5-7 mg/kg), Group B patients received Inj. Ropivacaine 0.75% 50 ml+1ml Inj. Ketorolac(30 mg) and Group C patients received Inj Ropivacaine 0.75% 50 ml+ Inj Tramadol 2ml (100mg), all diluted with NS to make 100 ml infiltration. Post-operative pain scores, time of first rescue analgesia (FRA), hemodynamic parameters and total rescue analgesic consumed in 24 hrs. as Inj Diclofenac and Tramadol was assessed and any untoward incidences like nausea, vomiting, knee swelling & Hypotension etc. were noted. The VA Score was significantly lower in Grp C as compared to Grp B and A in first 4-6 hrs. as tramadol and ketorolac significantly prolongs the duration of analgesia. VA score in Grp Cis 3.8+_0.52, as compared to 4.02 ± 1.58 in Grp B and 5.7 ± 1.014 in Grp A. which was statistically significant (P value 0.0141). The time of first rescue analgesia (FRA) was also prolonged by 2.2 hrs. in Grp C as compared to Grp B and C which is statistically significant. (P value 0.003). The total rescue analgesia in 24 hrs. given as Inj Diclofenac and Inj Tramadol was significantly lower in Grp C as compared to Grp B and A. No of pts requiring rescue analgesia was also less 45% in Grp C as compared to 50% and 95% in Grp B and A respectively. 25% pts in Grp C has excellent pain relief as compared to 20% in Grp B and 10% in Grp A. No untoward effect like nausea vomiting is noted in any patient, only 3 pts in Grp A and 2 pts in Grp B required bl transfusion. Local infiltration of Ropivacaine provides good analgesia. Addition of tramadol or Ketorolac prolongs the analgesic effect of Ropivacaine and lowers the VAS significantly and improves patient satisfaction score. It also decreases post-operative 24hrs NSAID or opioid consumption.

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Virtual reality may reduce anxiety and enhance surgical experience during wide-awake local anaesthesia no tourniquet surgery: A report of two cases

Journal of Perioperative Practice ◽

10.1177/1750458920984048 ◽

2021 ◽

pp. 175045892098404

Author(s):

Goutam Krish ◽

Igor Immerman ◽

Sakura Kinjo

Keyword(s):

Virtual Reality ◽

Case Report ◽

Local Anaesthesia ◽

Hand Surgery ◽

Perioperative Period ◽

The Novel ◽

Patient Anxiety ◽

Surgical Experience ◽

Wide Awake ◽

No Tourniquet

Virtual reality is an immersive experience that has been gaining acceptance in the field of medicine as a tool for reducing patient anxiety. We recently observed the effectiveness of this technology in wide-awake local anaesthesia no tourniquet (WALANT) surgeries. Here we report two cases of patients who used a virtual reality device during hand surgery using the WALANT technique. Both patients reported that the use of VR technology reduced their anxiety and improved their overall experience during surgery. This case report highlights the novel use of virtual reality during hand surgeries where the patients were awake. Based on these two cases, virtual reality may have the potential to reduce anxiety during the perioperative period and enhance a patient’s overall experience in WALANT surgeries.

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