Awake Local Anesthesia Research Articles

Use of the WALANT technique in osteosynthesis of the distal radius: Description of a case

Distal radius fractures are the most common fractures of the upper limb. It is a common fracture in the elderly and the indiction of an osteosynthesis by locked plate is often posed in view of the osteopenia. Surgical fixation of distal radius fractures under local anesthesia with the patient wide awake without a tourniquet allows intraoperative testing of fixation stability under active mobilization. This technique allows elderly people with extensive comorbidities to avoid the adverse effects commonly associated with general anesthesia or axillary blocks. The WALANT anesthesia technique (awake local anesthesia without tourniquet) consists of an injection of a local anesthetic of lidocaine and epinephrine into the operating field and without the use of a tourniquet. This article reports the detailed management under WALANT of osteosynthesis of the distal radius in an elderly patient presenting with extensive comorbidities.

The effect of sevoflurane anesthesia for dental procedure on neurocognition in children: a prospective, equivalence, controlled trial

BackgroundDental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children’s life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to whether DGA in children has an adverse effect on neurocognition.MethodsIn this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition was used to evaluate the neurocognitive function of children at 6 months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. The predefined clinical equivalence margin was 5 (1/3 SD of FSIQ score). If the 95% CI of the difference between the average FSIQ score of the two groups is within − 5 to + 5, then the two groups are equivalent.ResultsThe outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110–160). The mean FSIQ score in the general anesthesia group was 103·12 (SD 8.94), and the mean of the local anesthesia group was 103·58 (SD 8.40). There was equivalence in means of FSIQ score between the two groups (local minus general anesthesia 0.46, 95% CI − 2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Only the mother’s education could affect the primary outcome.ConclusionsIn this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurocognitive function at 6 months after surgery compared with awake-local anesthesia.Trial registrationChinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018.