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 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.

Complications After Clinic-Based Wide Awake Local Anesthesia No Tourniquet Hand Surgery at a Single Private Practice

Hand ◽  
2020 ◽  
pp. 155894472097513
Author(s):  
Michael Reynolds ◽  
Ramesh C. Srinivasan ◽  
David W. Person
Keyword(s):  
Foreign Body ◽  
Carpal Tunnel ◽  
Private Practice ◽  
Carpal Tunnel Release ◽  
Extensor Tendon ◽  
Hand Surgery ◽  
Foreign Body Removal ◽  
Wide Awake ◽  
No Tourniquet ◽  
A1 Pulley

Background This study was designed to analyze the results of all wide awake local anesthesia no tourniquet (WALANT) procedures performed on the hand and wrist at a single practice hand surgery practice with a focus on quantifying and qualifying complications. Methods This retrospective chart review included 424 patients who underwent WALANT hand procedures in the minor procedure room of our private practice between 2015 and 2017. Patients were divided into groups based on the type of procedure, including carpal tunnel release, A1 pulley release, first dorsal compartment release, extensor tendon repair, mass excision, and foreign body removal. Data pertaining to patient demographics and complications were recorded. Results The overall complication rate for all procedures was 2.8% for 424 patients: A1 pulley release (n = 314, 2.5%), first dorsal compartment release (n = 11, 9%), extensor tendon repairs (5.5%), and mass excision (4%). The carpal tunnel release and foreign body removal groups experienced no complications. No adverse events (arrhythmias, vasovagal, etc.) were observed during the use of the WALANT technique. Conclusions Clinic-based WALANT hand surgery procedures are equally safe compared to the same procedures performed in the operating room at an ambulatory surgery center or hospital.

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.

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 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.

Wide Awake Local Anesthesia No Tourniquet: A Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center

2019 ◽  
Vol 24 (04) ◽  
pp. 389-391
Author(s):  
Ian Jason Castro Magtoto ◽  
David Limlingan Alagar
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Daily Activity ◽  
Carpal Tunnel Release ◽  
Case Series ◽  
Hand Surgery ◽  
Great Success ◽  
Intraoperative Bleeding ◽  
Wide Awake ◽  
No Tourniquet

Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) uses a mixture of lidocaine and epinephrine for anesthesia and has found great success in hand surgery. At the Philippine Orthopedic Center (POC), we still use local anesthesia along with a tourniquet which gives the patient pain and discomfort at the tourniquet site. This study aims to determine perioperative and post-operative pain, intraoperative bleeding and immediate clinical outcomes of patients using WALANT for surgical anesthesia for carpal tunnel release. Methods: A case series of all patients who underwent carpal tunnel release under WALANT from April 2016 to September 2016 is presented. Those with concomitant trigger finger and de quervain disease which required release on the affected hand were also included. A tourniquet was on standby in case of uncontrollable bleeding. Intraoperative bleeding, pain NRS scores, and return to daily activity were noted. Results: Thirteen patients were included in the study; 3 were male, 10 were female. Mean age was 58 years, Mean surgical time was 15 minutes. Twelve were reported to have “some bleeding” and one was reported to have “bleeding but was still manageable”. None of the surgeries were totally bloodless or had too much bleeding that necessitated a tourniquet. Pain NRS scores during injection of local anesthesia had a mean of 2. None of the patients felt pain during and immediately after the surgery. Average time return to daily activity was 6 days. No complications were noted. Conclusions: Patients included in the study who underwent carpal tunnel release under WALANT did not experience pain associated with a tourniquet. Visualization of the field was adequate enough for the surgeons to do the surgery without the need for a tourniquet and with no associated complications.

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.

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Ian Wellington ◽  
Antonio Cusano ◽  
Joel V. Ferreira ◽  
Anthony Parrino
Keyword(s):  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Postanesthesia Care Unit ◽  
Complication Rates ◽  
Endoscopic Carpal Tunnel Release ◽  
Average Operating ◽  
Wide Awake ◽  
No Tourniquet ◽  
Room Time

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

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.

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