Wide Awake Local Anesthesia No Tourniquet Technique in Hand Surgery: The Patient Experience

Abstract

Background: We attempted to evaluate patient satisfaction and overall experience during wide awake, local anesthesia, with no tourniquet (WALANT) hand surgery and quantify surgery-related outcomes. Methods: We conducted a retrospective analysis of patient demographics, comorbidities, and patient reported outcomes via Single Assessment Numeric Evaluation (SANE) scores collected pre- and postoperatively of patients undergoing WALANT surgery by the 2 participating senior authors. A solution of 1% lidocaine with 1:100,000 epinephrine was used by 1 surgeon, while the other used a 1:1 ratio of 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine for local anesthetic injection. Patients were administered a postoperative survey to assess patient experience, including anxiety and pain levels, and overall satisfaction in the perioperative period. Results: Overall, 97.7% of patients indicated that they would undergo a WALANT-style surgery if indicated in the future, 70.5% ate the day of surgery, and a total of 39.1% of patients reported driving to and from surgery. Postoperative SANE scores increased as compared with preoperative scores across all patients. The use of combination 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine was associated with lower intraoperative and postoperative visual analog scale pain scores. Conclusions: WALANT hand surgery was generally well tolerated with excellent surgical outcomes. Patients reported ease of preparation for surgery, faster recovery, and lack of anesthetic side effects as the main benefits of wide-awake surgery. Combination use of lidocaine and bupivacaine may be better than lidocaine alone with respect to pain control in the initial recovery period.

Surgical Excision of Postaxial Polydactyly Type B in the Office Setting

“…In addition, although no formal cost analysis was performed, the economic burden on the family is clearly alleviated when the additional costs associated with an operating room and staff are removed. Several studies have already proven a significant cost benefit for wide awake local anesthesia no tourniquet surgery when compared with the same procedure performed under general anesthesia 25–28. As such, we feel that the surgeon’s office is the ideal setting for the surgical treatment of infants presenting with this common condition.…”

“…Several studies have already proven a significant cost benefit for wide awake local anesthesia no tourniquet surgery when compared with the same procedure performed under general anesthesia. [25][26][27][28] As such, we feel that the surgeon's office is the ideal setting for the surgical treatment of infants presenting with this common condition.…”

WALANT Technique Versus Conscious Sedation in Minor Hand Surgery

“…In accordance with our results, study of Lee et al, (8) as they reported that there was no statistically significant difference between WALANT and conventional groups as regard weight. Also, Pina et al, (9) demonstrated that there was no statistically significant difference between both studied groups as regard comorbidities.…”

What’s New in Hand and Wrist Surgery

“…A simulation recently showed that driving is theoretically not impaired with a bandaged, numb hand 70 . Pina et al reported that 39% of patients admitted having driven to and from the surgical procedure 69 , and a prospective study revealed that 29.5% of patients anonymously reported that they drove the day of the surgical procedure and 51.4% had returned to driving by the end of postoperative day 1 after outpatient hand surgery, regardless of anesthesia type. Thirty-four percent of patients in that study reported returning to driving while wearing a cast, splint, or sling 71 .…”