Modeled Wide-Awake, Local-Anesthetic, No-Tourniquet Surgical Procedures Do Not Impair Driving Fitness

Abstract

Background: The use of wide-awake, local-anesthetic, no-tourniquet (WALANT) surgical techniques is increasingly common, and patients commonly ask whether they may drive home following these procedures. The impact of a numb hand and bulky dressing on driving fitness is unknown, and there is no literature to guide surgeons when counseling these patients. Thus, the primary objective of the present study was to determine driving fitness following a modeled-WALANT procedure. Methods: Twelve right-handed individuals (6 male and 6 female) with an average age of 50 years (range, 38 to 64 years) were enrolled. An instrumented vehicle was used to obtain driving kinematic and behavioral data, thus allowing for a multidimensional assessment of driving fitness. Participants first performed a drive to establish baseline kinematic metrics. The route included both public streets and a closed course. Several driving tasks were assessed, including reverse parking, parallel parking, and perpendicular parking. The total course length was 18 miles (29 kilometers) and took 45 to 55 minutes to complete. After the first drive, 10 mL of 1% lidocaine was injected in the volar aspect of the right wrist and another 10 mL was injected into the right carpal tunnel to model the anesthetic used for a WALANT carpal tunnel release, and a bulky soft dressing was applied. The modeled-WALANT drive included an identical route and tasks, in addition to a surprise event to evaluate emergency responsiveness. Driving metrics were analyzed for noninferiority of the modeled-WALANT state to baseline driving. Results: The modeled-WALANT state showed noninferiority to baseline driving on all 11 analyzed dimensions of driving behavior compared with the control drives. In the modeled-WALANT state, participants drove more conservatively, braked harder, and steered more smoothly. All participants safely performed the 3 parking tasks and emergency response maneuver. Driving fitness in the modeled-WALANT state was noninferior to driving fitness in the preoperative drive. Conclusions: A modeled-WALANT state has no clinically relevant negative impact on driving fitness, and thus surgeons should not discourage patients from driving home after unilateral WALANT surgical hand procedures. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Patients Who Undergo Rotator Cuff Repair Can Safely Return to Driving at 2 Weeks Postoperatively

“…An a priori power analysis was performed using data from a previous study by our group 15 . The mean acceleration was used as the basis for the power analysis, as it is the most sensitive and easily interpreted measure to assess reckless driving behavior 18,19 .…”

“…To test our primary hypothesis, a noninferiority analysis was performed for each kinematic metric and was compared with limits that were set prior to data collection, predetermined by the researchers to be practically substantial (see Appendix 5). Using our previously described linear mixed-effects model estimates of the difference in driving fitness between baseline and postoperative drives, Bonferroni-corrected (56 total comparisons) 95% confidence intervals (CIs) of the model estimates for changes in driving from baseline were constructed 15 . A kinematic metric was deemed inferior if the 95% CI included the corresponding noninferiority limit.…”

“…Previously, our group evaluated driving fitness after modeled carpal tunnel release using instrumented vehicles in an on-road experimental design and discovered that the subjects modified their behavior to adapt to physical limitations, thus mitigating the effect of the postoperative state 15 . Here, we sought to examine if patients who had undergone RCR would similarly modify their behavior to adapt to their physical limitations and mitigate any postoperative effects.…”

Comparison of infraclavicular brachial plexus block versus wide-awake local anesthesia no-tourniquet technique in the management of radial shortening osteotomy

“…The waiting time for surgery has decreased. [17] It is more difficult for patients to tolerate the technique of WALANT psychologically. [12,18] Patients have excellent compliance when informed about the benefits of this approach.…”

Optimization of Carpal Tunnel Syndrome Using WALANT Method

“…Thompson Orfeld et al demonstrated that, following a unilaterally modelled WALANT procedure, patients' driving skills were not negatively impacted. This suggests it could be safe to drive home following a procedure under WALANT, which is not the case with other types of anesthesia [64]. Kang et al and Iqbal et al found patients who underwent CTR with WALANT reported similar postoperative functional outcomes as compared with comparison groups who received general anesthesia or wide-awake anesthesia with a tourniquet [62,65].…”