Elective Ambulatory Unit: Experience of Local Anesthetic Only Surgery During the Pandemic

Jeans, Edward; Talwalkar, Sumedh; Gebrye, Tadesse; Yeowell, Gillian; Fatoye, Francis; Hayton, Mike

doi:10.1177/15589447231158810

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Many hand surgical procedures can be safely and effectively performed in a clinic-based procedure room using wide awake local anesthesia with no tourniquet (WALANT). Transitioning cases to a procedure room has many benefits, including decreased medical waste, decreased cost, shorter wait for a surgical procedure, high patient satisfaction, favorable complication rates, and the ability to make operating room time available for more complex or profitable procedures 54-59 . One would conclude that performing minor hand surgery in a procedure room should be the standard of care.…”

Section: Practice Managementmentioning

confidence: 99%

What’s New in Hand Surgery

Bohn

2024

Journal of Bone and Joint Surgery

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Section: Practice Managementmentioning

confidence: 99%

What’s New in Hand Surgery

Bohn

2024

Journal of Bone and Joint Surgery

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“…Thus, the WALANT alternative is important in locations where general anesthesia resources are limited 46 . In addition, during the COVID-19 pandemic, wide-awake anesthesia was crucial for maintaining access to treatment for both trauma-related 47 and elective 48 hand or wrist problems.…”

Section: Advantages Of the Walant Techniquementioning

confidence: 99%

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

2023

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» Wide-awake local anesthesia no tourniquet (WALANT) technique featuring tumescent infiltration of lidocaine with epinephrine at the operative site has broad application in hand surgery including both soft-tissue and bone procedures.» The advantages of wide-awake anesthesia include high patient satisfaction, preserved intraoperative finger and wrist motion, cost-effectiveness, improved operating room efficiency, fewer opioids during recovery, and improved access to hand surgery, which may be performed in an office-based setting without the need for anesthesia personnel.» In properly selected patients, use of lidocaine with epinephrine in the hand and fingers is safe. Rare postprocedure digital ischemia may be effectively treated with phentolamine rescue.» Barriers to adopting wide-awake anesthesia may be overcome by educating resistant stakeholders, including hospital administrators, nurse leaders, and anesthesia colleagues, about the advantages of the WALANT method.» The risk of postoperative complications after hand procedures may be mitigated by using the wide-awake technique instead of regional anesthesia with sedation or general anesthesia.

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“…The adoption of WALANT anesthetic techniques allowed us to maintain ambulatory surgical activity during the pandemic period. Due to its advantages, some centers, including ours, continued this practice after the end of pandemic restrictions [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Wide-Awake Local Anesthesia No Tourniquet for Rhizarthrosis Surgery: Technique and Experience for 16 Consecutive Cases

Castelo,

Santos,

Costa

et al. 2023

Cureus

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Since it was described, wide-awake local anaesthesia no tourniquet (WALANT) has gained popularity. Our department has started using WALANT for hand surgery with increasing complexity. We present our results with WALANT rhizarthrosis surgery, including prosthetic replacement, trapeziectomy with suture button suspensionplasty and revision surgery. A retrospective review of all rhizarthrosis procedures under WALANT was performed from April 2021 to July 2022. We included patients who fulfilled inclusion criteria and had adequate imaging and clinical follow-up. A satisfaction survey was performed by telephone. Surgical time, complications, conversion to conventional anesthesia, pain, anxiety and global satisfaction were recorded. Tumescent anesthesia is performed 20-25 minutes before surgery, and is performed in four or five strategic locations that allow adequate anesthesia and vasoconstriction for the procedure to be comfortably carried out. We observed a series of 16 sequential surgeries involving 14 patients. All were female with a mean age of 65 years. Fourteen cases were performed due to primary rhizarthrosis, eight trapeziectomies with suture button suspensionplasty, six prosthetic replacements, and two revision surgeries. One patient needed to be converted to conventional anaesthesia due to anxiety during the procedure. Mean procedure time was 73 minutes. There were no WALANT-related complications. Mean patient-reported satisfaction with the anesthetic technique was a 9 (on a scale from 1 to 10) and 100% of patients would choose to undergo surgery with WALANT anesthesia for a future procedure. We find it useful to actively engage the patients during surgery to keep them comfortable and also help the surgeons assess stability and functional results. After wound closure, the hand is shown to the patient and he performs various tasks. There is somewhat of a learning curve for rhizarthrosis surgery under WALANT; patient comfort can be achieved through an adequate anesthetic technique and reassurance before and during surgery. We recommend that the first few cases be done in the presence of an anesthesiologist and a fasting patient in case there is a need to convert to conventional anesthesia. Wide awake rhizarthrosis surgery, even revision surgery, is safe and pain-free. Patient-reported satisfaction is also high. The authors find that including patient participation in their own surgery might be promising for post-op rehabilitation. There are limitations in this study such as the absence of a control conventional anesthesia group, the satisfaction questionnaire was not done immediately post-operatively, as such, a memory bias cannot be excluded, and it is not yet validated for the Portuguese population.

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Elective Ambulatory Unit: Experience of Local Anesthetic Only Surgery During the Pandemic

Cited by 4 publications

References 21 publications

What’s New in Hand Surgery

What’s New in Hand Surgery

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

Wide-Awake Local Anesthesia No Tourniquet for Rhizarthrosis Surgery: Technique and Experience for 16 Consecutive Cases

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