Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults

Abstract

Abstract Background Flexor tendon injuries represent a significant percentage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients undergoing flexor tendon repair. Patients and Methods In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm. Results Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p < 0.01) but time needed to obtain sufficient hemostasis is significantly more in WALANT than SC-BPB (p < 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p < 0.01). Conclusion WALANT anesthesia was found to be better alternative to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction.