Use of Wide-Awake Local Anaesthetic No Tourniquet (WALANT) in upper limb and hand surgery: A systematic review protocol

O’Neill, Niamh; Abdall-Razak, Ali; Norton, Emma; Kumar, Aneeta; Shah, Heer V.; Khatkar, Harman; Alsafi, Zaid; Agha, Riaz

doi:10.1016/j.isjp.2020.03.001

Cited by 22 publications

(21 citation statements)

References 16 publications

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“… 1 , 2 Since its introduction, the adoption of the anesthetic technique has gained significant traction for its favorable outcomes and patient satisfaction. 3 – 5 With the wide-awake method, analgesia is delivered directly to the operative site through a local injection containing lidocaine and epinephrine. 6 The ability to perform common hand procedures without the use of a tourniquet avoids pain and discomfort experienced by the awake patient while providing optimal pain control and hemostasis.…”

Section: Introductionmentioning

confidence: 99%

“… 2 , 7 The inherent advantages of WALANT offer patients the convenience of fewer office visits while sidestepping the need to obtain preoperative clearances and preprocedure fasting. 5 Moreover, procedures can be performed in an office setting, resulting in sizable cost savings. 8 , 9 Despite early criticism for its combined use of lidocaine with epinephrine, the proposed risks of vasoconstrictive-induced ischemia and tissue necrosis have been negligible, and promising outcomes have provided supporting evidence for its continued use.…”

Section: Introductionmentioning

confidence: 99%

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Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Kurtzman

Etcheson

Koehler

2021

Plastic and Reconstructive Surgery - Global Open

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Background: The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT. Methods: A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety. Results: The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates. Conclusions: The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Kurtzman

Etcheson

Koehler

2021

Plastic and Reconstructive Surgery - Global Open

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“…The possibility to operate without a tourniquet is a major benefit for patients and surgeons [1,4,28]. The WALANT technique makes the surgeon independent of anesthesiologists and allows more flexibility in scheduling surgical treatments.…”

Section: Discussionmentioning

confidence: 99%

WALANT–Epinephrine injection may lead to short term, reversible episodes of critical oxygen saturation in the fingertips

Moog

Dozan

Betzl

et al. 2021

Arch Orthop Trauma Surg

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Introduction Although the WALANT technique’s long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels. It was hypothesized that, temporarily, critical levels of tissue perfusion may occur. Methods Seventeen patients, who were scheduled for different procedures in WALANT technique, were injected with 5–7 ml of 1% Articain containing 1:200,000 epinephrine at the finger base. Capillary-venous oxygen saturation, hemoglobin volume in the capillaries, and relative blood flow in the fingertips were recorded once per second by white light spectrometry and laser Doppler flowmetry before, during and after injection for an average of 32 min. Results Clinically, no persistent tissue malperfusion was observed, and there were no postoperative complications. Capillary-venous oxygen saturation was reduced by ≥ 30% in seven patients. Critical levels of oxygen saturation were detected in four patients during 13 intervals, each lasting for 132.5 s on average. Oxygen saturation returned to noncritical values in all patients by the end of the observation period. Blood flow in the fingertips was reduced by more than 30% in nine patients, but no critical levels were observed, as with the hemoglobin. Three patients demonstrated a reactive increase in blood flow of more than 30% after injection. Conclusions Injection of tumescent local anesthesia containing epinephrine into finger base may temporarily cause a substantial reduction in blood flow and lead to critical levels of oxygen saturation in the fingertips. However, this was fully reversible within minutes and does not cause long-term complications.

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“…La dosis depende del tipo de procedimiento quirúrgico que se va a realizar, pero hay que tener en cuenta que la vasoconstricción se produce alrededor de los 30 minutos después de la infiltración 4 . Además, se ha documentado que el rango de dosis de seguridad es de 7 mg/kg de lidocaína con epinefrina 12 .…”

Section: Técnica Walantunclassified

Ahorro del costo de hospitalización con técnica WALANT en la resolución quirúrgica del síndrome del túnel carpiano y tenosinovitis de De Quervain. Evaluación de costos en un hospital privado de Quito, Ecuador

Cayón

Serrano

2021

Cir. Mano Microcir

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Introducción. El interés en los beneficios del uso de técnicas anestésicas regionales en ortopedia y traumatología ha aumentado en los últimos años ya que estas permiten realizar varios procesos quirúrgicos en la mano y en la muñeca de forma segura y ambulatoria, y sin los efectos secundarios de la anestesia general ni la necesidad de monitorización en la unidad de cuidados posanestésicos, disminuyendo así el uso de los recursos hospitalarios. Objetivo. Estimar el valor promedio de ahorro en los gastos en procedimientos quirúrgicos de la mano en pacientes atendidos con la técnica WALANT comparada con anestesia general. Materiales y métodos. Se compararon los costos que ocasionaron 14 pacientes operados mediante la técnica WALANT versus los ocasionados por 13 pacientes operados bajo anestesia general. Resultados. Las cirugías realizadas mediante técnica WALANT implicaron un menorcosto en comparación a las ejecutadas bajo anestesia general. Conclusiones. La cirugía del síndrome del túnel carpiano y tenosinovitis de De Quervain bajo anestesia local sin torniquete y con el paciente despierto (técnica WALANT) permite disminuir los costos en un promedio de US$391,80 (54.36%).

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Use of Wide-Awake Local Anaesthetic No Tourniquet (WALANT) in upper limb and hand surgery: A systematic review protocol

Cited by 22 publications

References 16 publications

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

WALANT–Epinephrine injection may lead to short term, reversible episodes of critical oxygen saturation in the fingertips

Ahorro del costo de hospitalización con técnica WALANT en la resolución quirúrgica del síndrome del túnel carpiano y tenosinovitis de De Quervain. Evaluación de costos en un hospital privado de Quito, Ecuador

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