Wide Awake Local Anesthesia No Tourniquet Technique in Hand Surgery: The Patient Experience

Hand ◽  
2021 ◽  
pp. 155894472110588
Author(s):  
Matthew Pina ◽  
Antonio Cusano ◽  
Matthew R. LeVasseur ◽  
Rafael Olivieri-Ortiz ◽  
Joel Ferreira ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Patient Experience ◽  
Recovery Period ◽  
Hand Surgery ◽  
Perioperative Period ◽  
Awake Surgery ◽  
Patient Reported ◽  
Local Anesthetic Injection ◽  
Wide Awake ◽  
No Tourniquet

Background: We attempted to evaluate patient satisfaction and overall experience during wide awake, local anesthesia, with no tourniquet (WALANT) hand surgery and quantify surgery-related outcomes. Methods: We conducted a retrospective analysis of patient demographics, comorbidities, and patient reported outcomes via Single Assessment Numeric Evaluation (SANE) scores collected pre- and postoperatively of patients undergoing WALANT surgery by the 2 participating senior authors. A solution of 1% lidocaine with 1:100,000 epinephrine was used by 1 surgeon, while the other used a 1:1 ratio of 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine for local anesthetic injection. Patients were administered a postoperative survey to assess patient experience, including anxiety and pain levels, and overall satisfaction in the perioperative period. Results: Overall, 97.7% of patients indicated that they would undergo a WALANT-style surgery if indicated in the future, 70.5% ate the day of surgery, and a total of 39.1% of patients reported driving to and from surgery. Postoperative SANE scores increased as compared with preoperative scores across all patients. The use of combination 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine was associated with lower intraoperative and postoperative visual analog scale pain scores. Conclusions: WALANT hand surgery was generally well tolerated with excellent surgical outcomes. Patients reported ease of preparation for surgery, faster recovery, and lack of anesthetic side effects as the main benefits of wide-awake surgery. Combination use of lidocaine and bupivacaine may be better than lidocaine alone with respect to pain control in the initial recovery period.

Virtual Reality Improves the Patient Experience during Wide-Awake Local Anesthesia No Tourniquet Hand Surgery

2019 ◽  
Vol 144 (2) ◽  
pp. 408-414 ◽  
Author(s):  
Ediana Hoxhallari ◽  
Ian J. Behr ◽  
Jonathan S. Bradshaw ◽  
Michael S. Morkos ◽  
Pam S. Haan ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Local Anesthesia ◽  
Patient Experience ◽  
Hand Surgery ◽  
Wide Awake ◽  
No Tourniquet

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

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

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.

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

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)

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

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

Patient Concerns About Wide-Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery

2021 ◽  
Author(s):  
Marie T. Morris ◽  
Elizabeth Rolf ◽  
Yash R. Tarkunde ◽  
Christopher J. Dy ◽  
Lindley B. Wall
Keyword(s):  
Local Anesthesia ◽  
Hand Surgery ◽  
Patient Concerns ◽  
Wide Awake ◽  
No Tourniquet

scholarly journals Wide-Awake Anesthesia in the In-Office Procedure Room: Lessons Learned

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 481-485 ◽  
Author(s):  
Robert E. Van Demark ◽  
Hillary A. Becker ◽  
Matthew C. Anderson ◽  
Vanessa J. S. Smith
Keyword(s):  
Hand Surgery ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Lessons Learned ◽  
Awake Surgery ◽  
Office Procedure ◽  
Concurrent Use ◽  
Wide Awake ◽  
No Tourniquet ◽  
Procedure Room

Background: Wide-awake local anesthesia and no tourniquet (WALANT) has become more popular in hand surgery. Without a tourniquet, there is no need for preoperative testing or sedation. The use of lidocaine with epinephrine has allowed a larger variety of cases to be done safely in an outpatient setting instead of the hospital. “Minor field sterility,” which uses fewer drapes and tools to accomplish the same procedures, is a concept that is also gaining recognition. Methods: Investigation of hand surgeons performing a majority of cases using WALANT and minor field sterility was the beginning of seeing its potential at our institution. Administration was concerned about patient safety, cost-effectiveness, and patient satisfaction of the proposed changes. Analysis of our institution to determine location of these procedures was also imperative to using WALANT. Results: An in-office procedure room was built to allow for WALANT and minor field sterility. The requirements and logistics of developing an in-office procedure room for wide-awake surgery are reviewed in this article. Conclusions: The concurrent use of WALANT and minor field sterility has created a hand surgery practice that is cost-effective for the patient and the facility and resulted in excellent patient outcomes and satisfaction.

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