Patient satisfaction using wide-awake local anaesthesia no tourniquet (WALANT) in adults undergoing elective hand surgery: A systematic review and meta-analysis

Abstract

BackgroundWide-awake local anaesthesia no-tourniquet (WALANT) is increasing in popularity within hand surgery. However, evidence is unclear on patient satisfaction rates when WALANT is compared against other more traditional anaesthetic techniques where pneumatic tourniquets have been used. The present study aims to evaluate the patient satisfaction rates of WALANT techniques. MethodsA literature search was performed using PubMed, Embase, and Cochrane databases looking for observational and randomised controlled trials (RCT) studies from 2003 up to June 2023. The review was carried out amongst adults undergoing elective hand surgery. The mean difference in operation time, as well as the standardised mean difference (SMD) for patient satisfaction and postoperative pain (<24hrs), were computed using the random effects model. The quality of studies was evaluated using RoB-2 for RCTs and ROBINS-I observational studies respectively. Data were collated and a meta-analysis was performed. ResultsThere were 5 RCTs and 15 observational studies included in our analysis, comprising a total cohort of 1800 patients. 899 patients received WALANT (50.0%). Among the RCTs, patient satisfaction was found to be higher in patients receiving WALANT (SMD 1.01, 95% CI 0.11 – 1.92, p = 0.03, I² = 93%). Post-operative pain was found to be non-significant using WALANT (95% CI -3.72 – 0.03, p = 0.10, I² = 99%), as was operative time difference (95% CI -0.42 – 0.40, p = 0.96, I² = 0%) ConclusionThe use of WALANT in elective hand surgery potentially carries higher satisfaction rates compared with anaesthesia with tourniquets. Postoperative pain and operation time are also non-inferior in WALANT, but more robust studies are needed to verify these findings.