Effects of fixation of clavicle fracture using wide-awake local anesthesia no tourniquet (WALANT) technique on intra-operative bleeding volume, surgical duration, and post-operatively visual analog scale (VAS); A case series study

Kafiabadi, Meisam Jafari; Sabaghzadeh, Amir; Biglari, Farsad; Sadighi, Mehrdad; Ebrahimpour, Adel

doi:10.1016/j.injury.2022.11.063

Cited by 4 publications

(1 citation statement)

References 27 publications

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“…Moreover, WALANT surgery for lower extremity operations such as foot and ankle injuries has been successfully reported [ 12 - 15 ]. Multiple publications have demonstrated wide-awake local anesthesia as a safe option for open reduction and internal fixation (ORIF) of clavicle fractures [ 16 - 18 ]. However, no reports have reported its use in proximal humerus surgery.…”

Section: Introductionmentioning

confidence: 99%

Wide-Awake Local Anesthesia for a Proximal Humerus Fracture: A Case Report

Shepard,

Aluvaala,

Bamberger

2024

jocr

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Introduction: Over the past two decades, wide-awake local anesthesia no-tourniquet (WALANT) surgery has gained substantial popularity, challenging conventional assumptions regarding the safety of epinephrine. This report investigates the unprecedented expansion of the wide-awake local anesthesia technique beyond hand surgeries. It meticulously documents its successful application in a peri-implant proximal humerus fracture, presenting a fresh perspective on its safety and viability for managing intricate orthopedic injuries. Case Report: The subject of this study is a 61-year-old HIV-positive male with a history of recurrent falls, seeking treatment for a peri-implant proximal humerus fracture. Electing the wide-awake local anesthesia option due to financial constraints, the patient underwent a successful surgery. The technique employed involved precise administration of local anesthetic, facilitating fracture reduction, and plate replacement. Notably, the emphasis was placed on active patient participation during intraoperative assessment. Conclusion: This report extends the recognized utility of WALANT surgery beyond hand surgeries, demonstrating its versatility and potential transformative impact on health-care delivery. The study underscores the pivotal role played by wide-awake local anesthesia surgery in addressing challenges related to health-care accessibility. It presents a promising avenue for future orthopedic interventions and positions itself as a safe and viable option for patients in underserved areas globally. Keywords: Humerus, open reduction internal fixation, Wide-awake local anesthesia no tourniquet

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Section: Introductionmentioning

confidence: 99%

Wide-Awake Local Anesthesia for a Proximal Humerus Fracture: A Case Report

Shepard,

Aluvaala,

Bamberger

2024

jocr

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Complications and side effects of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta-analysis

Lawand,

Hantouly,

Bouri

et al. 2024

International Orthopaedics (SICOT)

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Purpose Wide-Awake Local Anaesthesia No Tourniquet (WALANT), a groundbreaking anaesthetic technique resurging in practice, warrants a comprehensive safety analysis for informed adoption. Our study aimed to identify complications/side effects of WALANT upper limb procedures through a systematic review and meta-analysis. Methods This PROSPERO-registered study was performed with strict adherence to PRISMA guidelines. Embase, OVIDMedline, Cochrane, Web of Science, and Scopus databases were searched until February 2023. Inclusion criteria involved English articles, reporting complications/side effects in primary WALANT upper limb surgeries. Outcomes included all complications and side effects, data on the anaesthetic mixture, publication year/location, study type, and procedures performed. The meta-analysis employed the Freeman-Tukey Double Arcsine Transformation, computed I2 statistics, and utilized common or random effects models for pooled analysis. Results 2002 studies were identified; 79 studies met the inclusion criteria representing 15,595 WALANT patients. A total of 301 patients had complications, and the meta-analysis using a random effects model provided a complication rate of 1.7% (95% CI: 0.93–2.7%). The most reported complications were superficial infection (41%, n = 123/300), other/specified (12%, n = 37/300), and recurrent disease (6.7%, n = 20/300). A decade-by-decade analysis revealed no statistically significant difference in complication rates spanning the last three decades (p = 0.42). Adding sodium bicarbonate to the anaesthetic solution significantly reduced postoperative complications (p = 0.025). Conclusion WALANT has a low overall complication rate of 1.7%, with no significant temporal variation and a significant reduction in complications when sodium bicarbonate is added to the anaesthetic solution. Our findings support the safety of WALANT in upper limb procedures. Registration PROSPERO: CRD42023404018.

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New Frontiers in Wide-Awake Surgery

Lalonde,

Gruber,

Ahmad

et al. 2024

Plastic &Amp; Reconstructive Surgery

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Learning Objectives: After studying this article, the participant should be able to: 1. Explain the most important benefits of wide-awake surgery to patients. 2. Tumesce large parts of the body with minimal pain local anesthesia injection technique to eliminate the need for sedation for many operations. 3. Apply tourniquet-free surgery to upper and lower limb operations to avoid the sedation required to tolerate tourniquet pain. 4. Move many procedures out of the main operating room to minor procedure rooms with no increase in infection rates to decrease unnecessary cost and solid waste in surgery. Summary: Three disruptive innovations are changing the landscape of surgery: (1) minimally painful injection of large-volume, low-concentration tumescent local anesthesia eliminates the need for sedation for many procedures over the entire body; (2) epinephrine vasoconstriction in tumescent local anesthesia is a good alternative to the tourniquet and proximal nerve blocks in extremity surgery (sedation for tourniquet pain is no longer required for many procedures); and (3) evidence-based sterility and the elimination of sedation enable many larger procedures to move out of the main operating room into minor procedure rooms with no increase in infection rates. This continuing medical education article explores some of the new frontiers in which these changes affect surgery all over the body.

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Effects of fixation of clavicle fracture using wide-awake local anesthesia no tourniquet (WALANT) technique on intra-operative bleeding volume, surgical duration, and post-operatively visual analog scale (VAS); A case series study

Cited by 4 publications

References 27 publications

Wide-Awake Local Anesthesia for a Proximal Humerus Fracture: A Case Report

Wide-Awake Local Anesthesia for a Proximal Humerus Fracture: A Case Report

Complications and side effects of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta-analysis

New Frontiers in Wide-Awake Surgery

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