The rise of wide awake hand surgery - Contribution from Turkey

Ayhan, Egemen; Özdemir, Emre; Gumusoglu, Ender; Çevik, Kadir; Eskandari, Metin Manouchehr

doi:10.5455/handmicrosurg.299709

Cited by 6 publications

(5 citation statements)

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“…15 Furthermore, this technique does not require preoperative testing or perioperative monitoring, has shorter postoperative anesthesia recovery times, and eliminates the need for a tourniquet, which has been associated with mechanical pain and nerve damage. [24][25][26][27][28] Numerous studies have published on the outcomes as they pertain to patients undergoing open CTR via varying 30 found that tourniquet use was associated with more pain and discomfort. Consistent with other published studies, no significant difference was observed regarding the ease of the surgeon to perform the procedure, as evidenced by the similar procedure durations and occurrences of technical difficulties.…”

Section: Discussionmentioning

confidence: 99%

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WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Wellington

Cusano

Ferreira

et al. 2021

Hand (New York, N,Y.)

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Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Wellington

Cusano

Ferreira

et al. 2021

Hand (New York, N,Y.)

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“…In the year 2018, Ayhan et al demonstrated their experience of using the WALANT technique over a two-year duration [ 13 ]. Out of the 682 hand procedures done, there were no instances of finger loss.…”

Section: Discussionmentioning

confidence: 99%

A Review of 1073 Cases of Wide-Awake-Local-Anaesthesia-No-Tourniquet (WALANT) in Finger and Hand Surgeries in an Urban Hospital in Malaysia

Abdullah

Hua

Yun

et al. 2021

Cureus

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BackgroundThe Wide-Awake-Local-Anaesthesia-No-Tourniquet (WALANT) technique achieves an almost bloodless field for clear visualization during surgeries. WALANT utilizes lidocaine and epinephrine for anesthesia and hemostasis, respectively, without the usage of sedation and tourniquet. This avoids the potential side effects of tourniquet-related pain and sedation-related complications. However, acceptance is still low due to concerns regarding the safety of epinephrine injection in the finger. There is a persistent belief that epinephrine can cause digital ischemia. PurposeTo evaluate retrospectively possible complications of hand surgeries performed using the WALANT technique. MethodsAll finger and hand procedures performed under the WALANT technique from June 2016 to May 2021 in an urban tertiary hospital were studied retrospectively. ResultsThere were a total of 1073 cases, of which 694 were females and 379 were males. The mean age was 55 years. Finger surgeries (e.g., trigger finger release, excision of finger lesions, removal of implants) consisted of 707 cases; and the rest (366 cases) were hand surgeries (e.g., carpal tunnel release, excision of hand lesions, removal of implants). In all cases reviewed, there were no instances of circulatory compromise. There were also no circumstances where usage of reversal with phentolamine is recorded. ConclusionWe believe that performing finger and hand surgeries using the WALANT technique is safe and beneficial. The usage of WALANT in hand surgeries avoids tourniquet pain. However, WALANT should be used with caution in those with vascular insufficiency or disease.

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“…The local anesthesia solution contained 1% lidocaine, 1:100,000 epinephrine, and 8.4% sodium bicarbonate. 9 A digital block was performed with 2 cc of local anesthetic at the palmar side of the proximal phalangeal crease. After the digital block anesthesia, 4 cc of tumescent local anesthesia was injected dorsally beginning from the metacarpophalangeal (MCP) joint and advancing through the proximal phalanx to the distal interphalangeal (DIP) joint.…”

Section: Methodsmentioning

confidence: 99%