Abstract
The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. The study group consisted of 120 patients in which local anesthesia with 1% lidocaine and 1: 100,000 epinephrine solution was used. The conditions requiring surgery were Dupuytren disease (DD) stages II and III affecting one or two digital rays, carpal tunnel syndrome (CTS), trigger finger (TF), rupture of the flexor pollicis longus (FPL) tendon. The amount of anesthetic used, onset time, intraoperative bleeding, surgeon’s comfort during surgery, patient’s comfort, operative time, the immediate postoperative complications and length of hospital stay were evaluated, correlations between these parameters being made with the help of SPSS 20.0 software using regressions (ANOVA), and taking into account Pearson correlation coefficients with statistical significance, alpha at most .05 and CI 95%. In the group of 120 operated patients (58 men - M and 62 female -F) (M/F ratio = 0.93), no cases of digital necrosis or other vascular complications were recorded. Also, the absence of tourniquets did not result in intraoperative bleeding causing discomfort to the surgeon. The amount of anesthetic varied, being less than that recommended in the literature in approximately 40% of the cases. In all cases, patient comfort and satisfaction were highest, and length of hospital stay was several hours. Phentolamine, an antidote used to reverse the effects of epinephrine, was not used in any case. The correlation coefficient between the amount of anesthetic and waiting time = 0.3372 (p = 0.0001) - positive, direct, moderate, and statistically significant correlation. The correlation coefficient between the amount of anesthetic and length of hospital stay = 0.2700 (p = 0.002) - positive, direct, weak and statistically significant correlation. Correlation coefficient between age and length of hospital stay = 0.1361 (p = 0.1380) - positive, direct, weak correlation, but statistically insignificant. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal. Keywords: local anesthesia, epinephrine, Dupuytren disease (DD), carpal tunnel syndrome (CTS), trigger finger (TF)
Highlights
The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world
Fallen into disgrace for a long time because of the supposition of being the cause of digital necrosis when injected locally, epinephrine proves to be a real help in local anesthesia when combined with 1% lidocaine
All these advantages have made the technique to be used in surgeries for carpal tunnel syndrome (CTS), Dupuytren disease (DD), trigger finger (TF), tendon reconstructions and transfers, hand fractures, trapezo-metacarpian joint (TMJ) arthroplasty, trapeziectomy for TMJ arthritis, distal radius fracture, arthroscopy, ankle fracture and required open reduction and internal fixation (ORIF) [4-11]
Summary
The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal. In a large 2005 study of 3110 patients, Lalonde used local anesthesia with a solution of 1% lidocaine and 1: 100,000 epinephrine in hand surgery, with no case of digital necrosis being reported [2]. For the statistical study, considered were the demographic and anatomical variables: sex, age, area of residence, affected hand, and surgical variables: amount of anesthetic solution used, onset time of anesthesia, waiting time for anesthesia, intraoperative bleeding, local pain, length of hospital stay. Statistical processing was performed using the SPSS 20.0 version software, using regressions (ANOVA), taking into account Pearson correlation coefficients with statistical significance, for alpha of at most .05 and CI 95%
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