An Economic Analysis of MAC Versus WALANT: A Trigger Finger Release Surgery Case Study

Codding, Jason L.; Bhat, Suneel B.; Ilyas, Asif M.

doi:10.1177/1558944716669693

Cited by 72 publications

(69 citation statements)

References 11 publications

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“…In recent years, local anaesthesia has become popular and gained acceptance among hand surgeons from many countries (Gong and Xing, 2017;Kasmers et al, 2018;Lalonde, 2014;Lalonde and Martin, 2014; Roberti del Vecchio et al, 2015) for procedures reaching from trigger finger release (Codding et al, 2017) to more complex procedures such as nerve transposition, tendon transfers (Lamouille et al, 2017) or trapeziometacarpal joint replacements (Müller et al, 2018). One of those techniques, also referred to as ''wide awake local anaesthesia no tourniquet'' (WALANT) (Lalonde, 2017), implies that the patient's anaesthesia is achieved by local injections by the surgeon, thus removing the need for an anaesthesiologist.…”

Section: Introductionmentioning

confidence: 99%

Economic impact of anaesthesia methods used in hand surgery: Global costs and operating room's throughput

Boccard

Müller

Christen

2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Section: Introductionmentioning

confidence: 99%

Economic impact of anaesthesia methods used in hand surgery: Global costs and operating room's throughput

Boccard

Müller

Christen

2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…This study reinforces prior findings that WALA is a cost-effective and safe technique for simple hand surgical procedures. 4,7 Although a strength of this study is the vast patient population pulled from all regions of the country, there are limitations with a large administrative database. The analysis depends heavily on the accuracy of patient coding.…”

Section: Discussionmentioning

confidence: 99%

Wide-Awake Local Anesthesia for Minor Hand Surgery Associated With Lower Opioid Prescriptions, Morbidity, and Costs: A Nationwide Database Study

Lalchandani

Halvorson

Rahgozar

et al. 2020

Journal of Hand Surgery Global Online

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We sought to investigate the perioperative opioid prescription patterns, complication rates, and costs associated with wide-awake local anesthesia (WALA) techniques using a nationwide insurance claims-based database. Methods: We used the PearlDiver Humana administrative claims database to identify opioid-naive adult patients who underwent a carpal tunnel release, trigger finger release, or de Quervain release between 2007 and 2015. Patients were divided into WALA and standard anesthesia groups by the presence or absence of anesthesia Current Procedural Terminology codes. We evaluated for differences in perioperative opioid prescribing patterns, rates of opioid refills, and insurance reimbursement. The incidence of surgical complications and medical complications within 30 days of surgery were determined by International Classification of Diseases, Ninth Revision codes. Adjusted odds ratios were calculated with multivariable logistic regression models to identify factors associated with filling or refilling opioid prescriptions and complication rates. Results: There were 6,285 patients in the WALA group and 28,657 in the standard anesthesia group. The WALA patients were prescribed significantly lower quantities of opioids than were standard anesthesia patients across all 3 procedures. After controlling for type of surgery, gender, and comorbidities in a multivariate model, WALA patients were less likely to fill an initial opioid prescription during the perioperative period but were equally likely to obtain a refill. The WALA patients had lower odds of developing both surgical and medical complications compared with standard anesthesia patients. Moreover, WALA was associated with significantly lower costs for all procedures. Conclusions: Wide-awake local anesthesia technique is an increasingly common and viable option for minor hand surgery. It is a cost-effective and safe technique for simple hand surgical procedures and can be a strategy to minimize postoperative opioid use. Type of study/level of evidence: Prognostic II.

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“…WALANT technique is becoming increasingly popular in hand and wrist surgery. Compared with other anesthesia methods, it is reported as a usually reliable, cost-effective and timesaving procedure (17)(18)(19). Other advantages of the technique include avoidance of tourniquet-related pain and other complications and evaluation of perioperative active movements via patient cooperation.…”

Section: Discussionmentioning

confidence: 99%

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

Kır¹,

Bayraktar²,

Gürbüz³

2019

eamr

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Objective: Carpal tunnel syndrome is a common complaint in orthopedic practice and usually treated with surgical intervention. The aim of the study was to compare wide awake local anesthesia no tourniquet (WALANT) technique with general anesthesia and arm tourniquet in Carpal tunnel cases. Methods: Fifty-two patients who underwent surgery for Carpal tunnel syndrome were retrospectively divided into two groups as WALANT technique (Group W) and general anesthesia with arm tourniquet (Group G). In addition to the demographic data, visual analog scale (VAS), opioid consumption, early complications, duration of stay in operating room (DSOR) and first analgesic need time were evaluated. Results: When both groups were evaluated, early postoperative VAS scores, opioid consumption and DSOR were significantly lower in Group W than in Group G. Conclusion: In conclusion, WALANT technique was associated with reduced early postoperative pain, lower DSOR and opioid consumption compared to general anesthesia with tourniquet method for carpal tunnel release.

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An Economic Analysis of MAC Versus WALANT: A Trigger Finger Release Surgery Case Study

Cited by 72 publications

References 11 publications

Economic impact of anaesthesia methods used in hand surgery: Global costs and operating room's throughput

Economic impact of anaesthesia methods used in hand surgery: Global costs and operating room's throughput

Wide-Awake Local Anesthesia for Minor Hand Surgery Associated With Lower Opioid Prescriptions, Morbidity, and Costs: A Nationwide Database Study

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

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