Abstract
IntroductionAlthough the WALANT technique’s long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels. It was hypothesized that, temporarily, critical levels of tissue perfusion may occur.MethodsSeventeen patients, who were scheduled for different procedures in WALANT technique, were injected with 5–7 ml of 1% Articain containing 1:200,000 epinephrine at the finger base. Capillary-venous oxygen saturation, hemoglobin volume in the capillaries, and relative blood flow in the fingertips were recorded once per second by white light spectrometry and laser Doppler flowmetry before, during and after injection for an average of 32 min.ResultsClinically, no persistent tissue malperfusion was observed, and there were no postoperative complications. Capillary-venous oxygen saturation was reduced by ≥ 30% in seven patients. Critical levels of oxygen saturation were detected in four patients during 13 intervals, each lasting for 132.5 s on average. Oxygen saturation returned to noncritical values in all patients by the end of the observation period. Blood flow in the fingertips was reduced by more than 30% in nine patients, but no critical levels were observed, as with the hemoglobin. Three patients demonstrated a reactive increase in blood flow of more than 30% after injection.ConclusionsInjection of tumescent local anesthesia containing epinephrine into finger base may temporarily cause a substantial reduction in blood flow and lead to critical levels of oxygen saturation in the fingertips. However, this was fully reversible within minutes and does not cause long-term complications.
Highlights
The Wide Awake Local Anesthesia No Tourniquet” (WALANT) technique’s long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels
Therein, this study focused on capillary-venous oxygen saturation (sO2), hemoglobin volume in the capillaries, and relative blood flow in the fingertips
Only 17 of initially 21 patients (9 women, 8 men) with a mean age of 55 years could be included. They were scheduled for different procedures (15 patients: trigger finger release, 1 patient: mucoid cyst extirpation, 1 patient: removal of screw) using the WALANT technique, wherefore they were injected with 5–7 ml of 1% Articain containing 1:200,000 epinephrine subcutaneous at the palmar finger base, using a standardized technique as described by Harbison [21]
Summary
The WALANT technique’s long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels. Conclusions Injection of tumescent local anesthesia containing epinephrine into finger base may temporarily cause a substantial reduction in blood flow and lead to critical levels of oxygen saturation in the fingertips. This was fully reversible within minutes and does not cause long-term complications. This proved effective in a third patient, whose postoperative finger ischemia could be reversed that way, saving the digit [15] With regard to these case reports, one must consider, Archives of Orthopaedic and Trauma Surgery (2021) 141:527–533 that in the time span they occurred, several thousand other operations in WALANT technique were performed successfully, without complications. Cases that benefit in particular from WALANT technique are tendon surgery [1, 2, 4] and osteosynthesis [16, 17]
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