Abstract
Background Additional studies on clinical outcomes to determine the optimal time delay from injection of local anesthesia to skin incision for WALANT surgeries are needed. The authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. Methods Thirty-four patients were consecutively recruited and allocated by either 7-min or 30-min delay for skin incision from local injection of epinephrine with lidocaine. Intraoperative bleeding and postoperative pain scores were analyzed between both groups by Mann–Whitney U-test, while complication rates were compared using Fisher's exact test. Results The present study did not find significant differences in mean intraoperative blood loss (8 ± 5.8 mL vs. 5 ± 2.2 mL, p=0.074), complication rates (18% vs. 0%, p=0.227), and mean pain scores (1.2 ± 0.5 vs. 1.4 ± 0.5, p=0.307) between the 7-min and 30-min groups. Conclusion The authors conclude that a waiting time of 7 min from the injection of local anesthesia is sufficient to achieve comparable clinical outcomes for minor hand and wrist surgeries under WALANT.
Highlights
Hand surgeries traditionally rely on tourniquet to minimize intraoperative bleeding
Use of upper arm tourniquet, can limit the duration of procedure due to excessive pain caused on some patients [2,3,4]. e wideawake local anesthesia no tourniquet (WALANT) technique [5], in which lidocaine and epinephrine are injected for local anesthesia and vasoconstriction, respectively, has been increasingly used for hand surgeries [1, 6, 7]. e WALANT technique enables the surgery to be performed with the patient fully awake and without upper arm tourniquet, which allows intraoperative assessment of function during the procedure [1, 5]
We categorized patient, disease, and treatment-related variables according to the time delay from the injection of local anesthesia to skin incision (Table 1). e 7-min group and the 30-min group had a mean age of 48 years and 53 years, respectively, and a male-to-female ratio of 1 : 1.12 for both groups. e mean time intervals of surgery from skin incision to closure, for the 7-min and 30-min groups, are 7.5 min and 6.8 min, respectively, while the mean length of skin incision is 1.7 cm for both groups
Summary
Hand surgeries traditionally rely on tourniquet to minimize intraoperative bleeding. upper arm tourniquet may cause pain and discomfort among wideawake patients without general anesthesia or brachial plexus block [1, 2]. Vasoconstriction by epinephrine is traditionally believed to be optimal at approximately 7 to 10 minutes (min) from the time of injection [8], McKee et al [8], in a prospective randomized trial, obtained the lowest cutaneous hemoglobin levels at roughly 26 min following injection of epinephrine In their follow-up prospective comparative series [9] on carpal tunnel surgeries performed by WALANT, waiting roughly 30 min after injection of epinephrine resulted near three-fold reduction in mean quantity of intraoperative bleeding. E authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. Conclusion. e authors conclude that a waiting time of 7 min from the injection of local anesthesia is sufficient to achieve comparable clinical outcomes for minor hand and wrist surgeries under WALANT
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