Wide Awake Local Anesthesia No Tourniquet: A Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center

Abstract

Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) uses a mixture of lidocaine and epinephrine for anesthesia and has found great success in hand surgery. At the Philippine Orthopedic Center (POC), we still use local anesthesia along with a tourniquet which gives the patient pain and discomfort at the tourniquet site. This study aims to determine perioperative and post-operative pain, intraoperative bleeding and immediate clinical outcomes of patients using WALANT for surgical anesthesia for carpal tunnel release. Methods: A case series of all patients who underwent carpal tunnel release under WALANT from April 2016 to September 2016 is presented. Those with concomitant trigger finger and de quervain disease which required release on the affected hand were also included. A tourniquet was on standby in case of uncontrollable bleeding. Intraoperative bleeding, pain NRS scores, and return to daily activity were noted. Results: Thirteen patients were included in the study; 3 were male, 10 were female. Mean age was 58 years, Mean surgical time was 15 minutes. Twelve were reported to have “some bleeding” and one was reported to have “bleeding but was still manageable”. None of the surgeries were totally bloodless or had too much bleeding that necessitated a tourniquet. Pain NRS scores during injection of local anesthesia had a mean of 2. None of the patients felt pain during and immediately after the surgery. Average time return to daily activity was 6 days. No complications were noted. Conclusions: Patients included in the study who underwent carpal tunnel release under WALANT did not experience pain associated with a tourniquet. Visualization of the field was adequate enough for the surgeons to do the surgery without the need for a tourniquet and with no associated complications.

Impact of WALANT Hand Surgery in a Secondary Care Hospital in Spain. Benefits to the Patient and the Health System

“…Releases performed with the standard anesthetic technique show complications in 1-25% of cases with reoperation rates of up to 12% ( Table 6 ). 50 , 51 , 52 , 53 , 54 , 55 , 56 Our study found a complication rate of 10.16 %, with a reoperation rate of 1.5 %. These differences may result from the small sample sizes used in the WALANT studies.…”

Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations

“…The absence of a completely bloodless operative field, otherwise afforded by a tourniquet, is generally accepted with WALANT. 25 Gunasagaran has shown no significant difference in estimated blood loss or operative time between WALANT and LA/TQ-based anesthetics. 26 Others have found that WALANT provided a better surgical field than a tourniquet for trigger finger release (TFR) amongst 86 patients.…”

Wide-Awake Local Anesthesia, No Tourniquet Surgery in the Philippines

“…The use of WALANT surgery is prevalent among hand surgeons. A pilot study on this was recently reported by Magtoto and Alagar 9 on their experience at a local government hospital on carpal tunnel syndrome. Although in their report, none were bloodless nor had too much bleeding, no complications were noted, and the pain was very well controlled in their 13 patients.…”