Metatarsal osteotomy for hallux valgus under wide-awake local anesthesia with no tourniquet technique

Abstract

Objectives The issue of performing a hallux valgus operation with the wide-awake local anesthesia with no tourniquet (WALANT) technique has not been evaluated before. The objective of this study was to compare the clinical results of patients who underwent the WALANT technique during hallux valgus operation and patients who underwent the procedure with traditional anesthesia (TA). Patients and methods In this cross-sectional, retrospective study, 34 patients (17 males, 17 females; mean age: 46.1±8.3 years; range, 36 to 62 years) who underwent first metatarsal osteotomy with the diagnosis of hallux valgus disease at the orthopedics and traumatology department of the Private Silivri Anadolu Hospital between November 1, 2018, and June 1, 2020, were divided into two groups according to the surgical approach determined by patient choice: the WALANT group and the TA group. Demographic characteristics, Visual Analog Scale (VAS) scores for pain and anxiety, postoperative satisfaction levels, and complications were recorded. Results There was no significant difference between the groups in terms of demographic characteristics. The VAS pain score during needle insertion was significantly higher in the WALANT group compared to the TA group (p<0.001). Conversely, the VAS anxiety score was significantly higher in the WALANT group compared to the TA group (p<0.001). The median follow-up time was 5.4 months (interquartile range, 5-6 months). Conclusion This is the first study demonstrating that adequate anesthetic efficacy can be achieved with the WALANT technique for the hallux valgus operation. Acceptable pain scores can be achieved with this technique, and costs are reduced.

Comparison of the effectiveness of the WALANT method in soft tissue and bone tissue surgeries in lower extremities

“…[8,9] Thanks to favorable results of WALANT in upper extremity surgery, it has also been used in lower extremity surgery. Pamuk et al, [2] in a comparative study with regional anesthesia, applied the technique in metatarsal osteotomies and achieved adequate anesthetic efficacy with acceptable pain scores. Bilgetekin et al, [11] in foot and ankle surgery, achieved good pain control and shorter hospital stay.…”

“…Complications after the use of WALANT in the lower extremities have been rarely reported. Pamuk et al[ 2 ] reported one superficial infection in 15 patients who underwent metatarsal osteotomy using the WALANT technique. Bilgetekin et al[ 11 ] reported no complications related to the WALANT technique in foot and ankle injuries, Similarly, Li et al[ 12 ] did not report any complications related to the WALANT technique in the treatment of ankle fractures.…”

“…To date, the number of studies on its use in lower extremity surgery is limited. [ 2 , 11 , 12 ] Concerns regarding causing necrosis in the extremity of epinephrine in hand surgery limit the use of the technique. The series of 3,110 patients by Lalonde et al[ 13 ] and the extensive review reported by Denkler[ 14 ] confirmed that it was not associated with a concerned complication that much.…”

“…As the patient remain awake during the procedure, tourniquet-free surgery by injection of lidocaine with epinephrine into the surgical field provides significant advantages. [1,2] However, tourniquet use has been associated with complications such as local ecchymosis, postoperative pain, neurovascular damage, muscle atrophy, thrombosis, and reperfusion injury. [3][4][5] As application of the technique continues to grow, the current literature suggests positive outcomes.…”

Comparison between bioabsorbable magnesium and titanium compression screws for hallux valgus treated with distal metatarsal osteotomies: A meta-analysis

“…Currently, distal metatarsal osteotomy (DMO) has been shown to be an effective technique for the correction of mildto-moderate HV deformities with a congruent metatarsophalangeal joint. [ 3 ]…”