Patients’ perspective of wide-awake hand surgery — 100 consecutive cases

2013 ◽  
Vol 38 (9) ◽  
pp. 992-999 ◽  
Author(s):  
I. Teo ◽  
W. Lam ◽  
P. Muthayya ◽  
K. Steele ◽  
S. Alexander ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Tendon Transfer ◽  
Hand Surgery ◽  
Postal Questionnaire ◽  
Awake Surgery ◽  
General Anaesthetic ◽  
Satisfaction Level ◽  
High Satisfaction ◽  
Wide Awake ◽  
Patients Perspective

The wide-awake hand surgery (WAHS) technique involves injecting lidocaine with adrenaline for hand surgical procedures that are done without the use of tourniquets, sedation, regional or general anaesthetic. This is a retrospective review of the first 100 consecutive patients who underwent operations using this technique at our centre. The operations included carpal and cubital tunnel decompression, trapeziectomy, tendon transfer, and tenolysis. A questionnaire adapted from Lalonde’s previous work on wide-awake surgery was used to assess patients’ experiences. Sixty-five percent of the patients responded to the postal questionnaire, the majority reporting a high satisfaction level. Ninety-one percent of responders reported that the operation was less painful or comparable with a procedure at the dentist; 86% would prefer to be wide-awake if they needed to have hand surgery again, and 90% stated they would recommend WAHS to a friend.

scholarly journals Timed wake-up anaesthesia in hand: A modification to wide awake surgery of hand

2016 ◽  
Vol 49 (03) ◽  
pp. 378-383 ◽  
Author(s):  
Jagannath Kamath ◽  
Trivikram Shenoy ◽  
Nikil Jayasheelan ◽  
Naufal Rizwan ◽  
Vartika Sachan ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Full Range ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Modified Technique ◽  
Upper Arm ◽  
Modified Method ◽  
Hand Wash ◽  
Wide Awake ◽  
Fine Tune

ABSTRACT Introduction: Wide awake surgery of the hand (WASH) is a well-accepted technique in hand surgery which allows the surgeon to identify and rectify on the table of some of the inadvertent shortcomings in the surgical procedures to optimise the final outcome. The advantage, however, precludes the use of tourniquet. We describe a modified method which preserves all the advantages of WASH and allows the surgeon to use tourniquet. Patients and Methods: Thirty-one cases of hand surgeries were carried out using the modified technique where a wrist block was supplemented with the ultra-short acting intravenous propofol which allowed the surgeon to use the upper arm tourniquet. The propofol infusion was stopped, and the tourniquet was released after the important surgical step. Within an average of 10 min of stoppage of the infusion, all the patients were awake for active intraoperative painless movements to aid the surgeon to identify, rectify and fine tune the procedure to optimise the results. Results: Five of the 31 patients needed correction based on the intraoperative movements. All the 31 patients were pain free at the surgical site during surgery. All the 31 patients were cooperative enough to perform full range of pain-free intraoperative movements. No patient experienced significant tourniquet pain during the procedure. Patient’s and surgeon’s satisfaction at the end of the procedure has been quite satisfactory. Conclusion: Timed wake-up anaesthesia, an improvement over the original WASH, has been suggested where the surgeon can add without subtracting the benefits of the procedure in the form of usage of the tourniquet providing the clear tissue plane and haemostasis during the surgery. However, an additional cost is incurred for the use of anaesthesia and equipment should be kept in mind.

Wide Awake Hand Surgery

2017 ◽  
Vol 22 (03) ◽  
pp. 292-296 ◽  
Author(s):  
Line Lied ◽  
Grethe E. Borchgrevink ◽  
Vilhjalmur Finsen
Keyword(s):  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Numerical Scale ◽  
Lidocaine Injection ◽  
One Year ◽  
Wide Awake ◽  
General Care ◽  
General Period

Background: “Wide awake hand surgery”, where surgery is performed in local anaesthesia with adrenaline, without sedation or a tourniquet, has become widespread in some countries. It has a number of potential advantages and we wished to evaluate it among our patients. Methods: All 122 patients treated by this method during one year were evaluated by the surgeons and the patients on a numerical scale from 0 (best/least) to 10 (worst/most). Theatre time was compared to that recorded for a year when regional or general anaesthesia had been used. Results: The patients’ mean score for the general care they had received was 0.1 (SD 0.6), for pain during lidocaine injection 2.4 (SD 2.2), for pain during surgery 0.9 (SD 1.5), and for other discomfort during surgery 0.5 (SD 1.4). Eight reported that they would want general anaesthesia if they were to be operated again. The surgeons’ mean evaluation of bleeding during surgery was 1.6 (SD 1.8), oedema during surgery 0.4 (SD 1.1), general disadvantages with the method 1.0 (SD 1.6) and general advantages 6.5 (SD 4.3). The estimation of advantages was 9.9 (DS 0.5) for tendon suture. 28 patients needed intra-operative additional anaesthesia. The proportion was lower among trained hand surgeons and fell significantly during the study period. Non-surgical theatre time was 46 (SD 15) minutes during the study period and 55 (SD 22) minutes during the regional/general period (p < 0.001). This gain was cancelled out by a longer surgery time during the wide awake period. Conclusions: Wide awake surgery is fully acceptable to most patients. It has a number of advantages over general or regional anaesthesia, but we feel it is unlikely to improve the efficiency of the operating theatre.

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 The efficacy of WALANT technique in Hand Surgery

2021 ◽  
Vol 12 (9) ◽  
pp. 136-141
Author(s):  
Niraj Ranjeet ◽  
Pratyenta Raj Onta ◽  
Krishna Sapkota ◽  
Pabin Thapa ◽  
Upendra jung Thapa ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Hand Surgery ◽  
Dental Procedure ◽  
Duration Of Surgery ◽  
Level 3 ◽  
The Mean ◽  
Procedural Components ◽  
Wide Awake ◽  
No Tourniquet ◽  
Better Than

Background: Nowadays, Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has gained popularity among surgeons because of its use in variety of surgical procedures because it provides excellent hemostasis, eliminating the need of tourniquet, sedation and the risk and cost of general anesthesia. Aims and Objective: In this study, we wanted to evaluate its efficacy and the experiences of the patients and surgeons in different hand surgeries. Materials and Methods: We had 108 patients who underwent various hand surgeries under WALANT technique. Patients and surgeons were requested to fill a questionnaire after the procedure. The procedure was evaluated in terms of the pain compared to a dental procedure, duration of the anesthesia, amount of bleeding and patients’ satisfaction. Results: The mean age of our patients was 42.7 years. A variety of hand surgery was performed in our study. The mean local anaesthetic volume used was 16.5 ml. The Tang grading system was used to evaluate the levels of surgeon’s experience; 75% of surgeons were a Level 2, 18% Level 3 and 7% Level 4. Sixty-four patients experienced WALANT to be less than, 30 patients equivalent to and 8 had more pain compared to a dental procedure. There was a significant correlation between volume of local anesthetic used, duration of surgery and number of procedural components repaired. Both pain and anxiety levels were significantly less intra-operatively and postoperatively as compared to the level at the time of injection. Eighty-seven patients considered it to be better than expected, and would prefer it in the future in case they have to undergo surgery. Conclusion: We observed that our patients were satisfied with their experience on WALANT technique and the surgical procedures, and we recommend the use of this for a variety of hand surgery procedures.

Anaesthesia

2018 ◽  
Author(s):  
Alistair Phillips ◽  
Harry Akerman
Keyword(s):  
Local Anaesthetic ◽  
Brachial Plexus Block ◽  
Hand Surgery ◽  
General Anaesthetic ◽  
Small Field ◽  
Muscle Paralysis ◽  
Peripheral Nerve Blockade ◽  
Without Tourniquet ◽  
Plexus Block ◽  
Wide Awake

Pain-free surgery can be imposed on the hand and wrist without resort to general anaesthetic. Options include local anaesthetic infiltration which can, in higher volumes mixed with adrenaline, allow surgery without a tourniquet. This technique (wide awake local anaesthetic without tourniquet or WALANT) permits the patient to move the fingers without the muscle paralysis induced by the regional anaesthetic and tourniquet, adding invaluable information, e.g. in tendon transfers. The efficacy of specific peripheral nerve blockade and brachial plexus block can be enhanced by ultrasound or nerve stimulation. Intravenous blockade (Bier’s) is effective. Tourniquets (finger, forearm, above elbow) are essential in hand surgery to provide a view unimpeded by blood (although WALANT can achieve this at the expense of a more oedematous field for procedures in a small field).

Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity

2021 ◽  
pp. 175319342110295
Author(s):  
Donald Lalonde ◽  
Egemen Ayhan ◽  
Amir Adham Ahmad ◽  
Steven Koehler
Keyword(s):  
Ulnar Nerve ◽  
Local Anaesthesia ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Decompression Surgery ◽  
Entrapment Neuropathies ◽  
Fracture Management ◽  
Without Tourniquet ◽  
Wide Awake ◽  
Nerve Decompression Surgery

Hand surgery is rapidly changing. The wide-awake approach, minimum dissection surgery and early protected movement have changed many things. This is an update of some of the important changes regarding early protected movement with K-wired finger fracture management, simplification of nerve decompression surgery, such as elbow median and ulnar nerve releases, and some new areas in performing surgery with wide-awake local anaesthesia without tourniquet.

Digital revascularization and replantation using the wide-awake hand surgery technique

2017 ◽  
Vol 42 (6) ◽  
pp. 621-625 ◽  
Author(s):  
JKF Wong ◽  
CH Lin ◽  
NJ Chang ◽  
HC Chen ◽  
YT Lin ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Case Series ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Tissue Necrosis ◽  
Level Of Evidence ◽  
Operator Experience ◽  
Soft Tissue Necrosis ◽  
Wide Awake ◽  
Superficial Soft Tissue

The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the ‘wide-awake’ anaesthetic technique. A temporary digital tourniquet (< 20 min) was used in three cases to identify structures quickly. The anastomoses were performed under local anaesthesia without a tourniquet. All cases had successful re-establishment of blood flow with good perfusion to the digital tips; no cases were re-explored because of vascular crisis. Four cases had minor superficial soft tissue necrosis that healed secondarily. We conclude that digital revascularization and replantation can be performed under local anaesthesia with use of adrenaline and without detriment to the traumatized digit provided careful patient selection and adequate operator experience are available. Level of evidence: IV

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.

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.

scholarly journals Wide-Awake Hand surgery

2021 ◽  
Vol 26 (1) ◽  
pp. 1-11
Author(s):  
Young Woo Kim
Keyword(s):  
Time Use ◽  
Systemic Risk ◽  
Surgical Procedure ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Injection Technique ◽  
Low Grade ◽  
Patient Anxiety ◽  
Short Time ◽  
Wide Awake

Wide-awake surgery is a surgical procedure which is not used a tourniquet and any sedation by using the function of lidocaine and epinephrine through the tumescent injection technique. The biggest advantages of wide-awake surgery are the prevention of the systemic risk of general anesthesia and the surgeon can confirm the result of surgery by moving the patient’s joint and tendon during the operation. But some modification of wide-awake surgery may be beneficial for the surgeon and patient. For decreasing the patient anxiety, low-grade sedative can be used and short-time use of tourniquet during initial dissection of the operating site can prevent the unexpected complication.

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