Conceptual origins, current practice, and views of wide awake hand surgery

2017 ◽  
Vol 42 (9) ◽  
pp. 886-895 ◽  
Author(s):  
Donald H. Lalonde
Keyword(s):  
Local Anaesthesia ◽  
Current Practice ◽  
Hand Surgery ◽  
Historical Background ◽  
The World ◽  
The Future ◽  
Recent Developments ◽  
Wide Awake ◽  
No Tourniquet

This article reviews historical background, essential practice principles, and the new emerging area of wide awake hand surgery. It outlines the reasons that wide awake, local anaesthesia, no tourniquet surgery has emerged so quickly in the last 10 years over the world. I explain the origin of the concepts and some of the challenges of getting the technique accepted; in particular, the debunking of the myth of epinephrine danger in the finger. I review the most recent developments in several operations in this rapidly changing field of the tourniquet-free approach. Finally, this review includes speculations on the future of this technique.

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

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

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.

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

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T M Borg ◽  
M Tahir ◽  
N Heidari
Keyword(s):  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Randomised Control Trial ◽  
P Value ◽  
Foot And Ankle ◽  
Post Procedure ◽  
Trimalleolar Fractures ◽  
Post Operative Pain ◽  
Wide Awake ◽  
No Tourniquet

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.

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

Manufacturing in the world: where next?

2015 ◽  
Vol 35 (9) ◽  
pp. 1253-1274 ◽  
Author(s):  
Louis Brennan ◽  
Kasra Ferdows ◽  
Janet Godsell ◽  
Ruggero Golini ◽  
Richard Keegan ◽  
...  
Keyword(s):  
Business Models ◽  
Customer Engagement ◽  
Future Research ◽  
Content Type ◽  
New Era ◽  
The World ◽  
The Future ◽  
Recent Developments ◽  
Consistent Feature ◽  
Manufacturing Network

Purpose – The past three decades have seen the transformation of manufacturing involving its global dispersion and fragmentation. However, a number of recent developments appear to suggest that manufacturing may be entering a new era of flux that will impact the configuration of production around the globe. The purpose of this paper is to address the major emerging themes that may shape this configuration and concludes that most of them are still in their initial stages and are not likely to create a radical shift in the next few years in how manufacturing is configured around the world. These themes were presented in a special session on “Manufacturing in the World – Where Next?” at the 2013 EurOMA Conference in Dublin, Ireland. Design/methodology/approach – The paper provides a series of perspectives on some key considerations pertaining to the future of manufacturing. An evaluation of their likely impact is offered and insights for the future of manufacturing are presented. Findings – The importance of a focus on the extended manufacturing network is established. The need for customer engagement and a forward looking approach that extends to the immediate customer and beyond emerges as a consistent feature across the different perspectives presented in the paper. There is both the potential and need for the adoption of innovative business models on the part of manufacturers. Originality/value – The paper presents in-depth perspectives from scholars in the field of manufacturing on the changing landscape of manufacturing. These perspectives culminate in a series of insights on the future of global manufacturing that inform future research agendas and help practitioners in formulating their manufacturing strategies.

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

2017 ◽  
Vol 25 (3) ◽  
pp. 230949901773949 ◽  
Author(s):  
Jayaletchumi Gunasagaran ◽  
Ee Soon Sean ◽  
Sachin Shivdas ◽  
Shams Amir ◽  
Tunku Sara Ahmad
Keyword(s):  
Local Anaesthesia ◽  
Wide Awake ◽  
No Tourniquet

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 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 ◽  
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

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.

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