WALANT Technique Research Articles

Pillar pain incidence, duration, and psychological correlations in WALANT. A prospective study of 170 patients

PurposeTo prospectively address our patients seeking carpal tunnel release (CTR) to evaluate the incidence, intensity, and duration of pillar pain (PP) and its correlation with catastrophic thinking, depression, and health anxiety.Methods: this is a prospective cohort study consisting of patients who underwent mini-open CTR under WALANT. Pillar pain was evaluated using the table test and was recorded as dichotomous variable and rated with a visual analogue scale (VAS). Patients with a positive result were evaluated on a monthly basis until the test yielded a negative result.To assess catastrophic thinking, health anxiety and depression levels, we employed the Pain Catastrophizing Scale (PCS) the Short Health Anxiety Inventory (SHAI), and the Beck scale respectively. ResultsThe study enrolled 170 patients who underwent CTR using WALANT technique. Among them, 84 patients (49 %) exhibited a positive table test. With exception of age and diabetes, both groups showed comparable demographic characteristics.The mean pain score for patients with a positive test was 3.5 ± 1.5, and the median duration of it was 3 months (interquartile range [IQR] 2–4). The median PCS score was 8 (IQR 2–14) in patients without PP, compared to 8 (IQR 4–11) in patients with PP. In the logistic regression model, the PCS variable had a crude odds ratio (OR) of 1 (95 % CI: 0.96–1.03) and an adjusted OR of 1 (95 % CI: 0.97–1.04). The SHAI score showed a crude OR of 0.97 (95 % CI: 0.93–1.01) and an adjusted OR of 0.97 (95 % CI: 0.92–1.01). The BECK score had a crude OR of 0.99 (95 % CI: 0.96–1.03) and an adjusted OR of 1.02 (95 % CI: 0.98–1.06). ConclusionPatients undergoing mini-open CTR have a risk of 49 % of experiencing PP, which typically registers a pain intensity of approximately 3 points and will last for a median of 3 months. The likelihood of experience it does not depend on catastrophic thinking, depression, and health anxiety. Type of study/level of evidencePrognostic II.

Indications and Early Outcomes of WALANT among Patients Undergoing Surgical Procedures at a Tertiary Care Hospital, Mwanza, Tanzania

Introduction: The concept of "Wide Awake Local Anesthesia No Tourniquet" (WALANT) technique is gaining popularity in the field of plastic, orthopedic and general surgery owing to its benefits of reduced cost, improved safety, improved patient satisfaction, avoiding costly preoperative tests, decreased operative time, reduced utilization of hospital resources and length of hospital stay. Objective: To determine indications for surgery and early outcomes of "Wide Awake Local Anesthesia No Tourniquet" among patients undergoing surgical procedures at Bugando Medical Centre (BMC). Method: This was a 4 months’ prospective longitudinal study conducted from April to July 2023 involving 91 patients aged 12 years and above who underwent surgical procedures from plastic, orthopaedics and general surgery departments at Bugando Medical Centre. Structured questionnaire was used to obtain operative information and the Visual Analogue Scale (VAS) was used to obtain intra operative pain score. Results: The most common indication for using WALANT was surgeon's preference (65/91,70%). The most common procedure done was sloughectomy (16/91,17.6%) the least being colostomy placement (1/91, 1.1%). Intraoperative VAS score range from 0 to 4 with a mean of 1.1 (±0.39). (88/91, 97%) of the participants had no any complication post-operatively and the majority of the remaining few presented with tachycardia (2/91, 2.2%). The level of satisfaction was significant associated with the length of hospital stay having the p-value of 0.00. Conclusions: The WALANT technique can be performed as the best alternative type of anesthesia for both minor and selected major surgeries with minimal pain score, high patient’s satisfaction rate, minimum risk of infection and significant reduced length of hospital stay.

A prospective comparison of WALANT technique and general anesthesia in forefoot surgery

IntroductionWide Awake Local Anesthesia No Tourniquet (WALANT) technique has been widely used in hand surgery, but there are few prospective data on its use in forefoot surgery. HypothesisThe WALANT technique reduces pain compared to general anesthesia for bone surgery on the first ray of forefoot. MethodsThis was a prospective, longitudinal, comparative, non-randomized cohort study in adult patients undergoing bone surgery on the first ray of forefoot. The primary objective was the level of pain (0–10 visual analogic scale) 4 h after the procedure with WALANT technique versus general anesthesia supplemented by ropivacaine infiltration. ResultsA total 37 patients were analyzed in the WALANT group and 24 in the general anesthesia group (women, 90.2%; mean age, 51.3 years; hallux valgus, 85.2%; first metatarsal osteotomy, 80.3%). After generalized linear regression adjusted on a priori defined factors, there was no statistically difference for pain ≤3 at 4 h in WALANT vs. general anesthesia (odds-ratio 1.66; 95% CI, 0.17–20.49; p = 0.2548). At 24 h, pain level was also comparable in the two groups. Time spent in operating room was significantly shorter with WALANT (40.8 vs. 49.7 min; p = 0.0001). Mean length of stay in the recovery room was also significantly shorter with WALANT (4.4 vs. 75.6 min; p < 0.0001). Anxiety before/after surgery, uptake of analgesic/anti-inflammatory drugs and quality of life were comparable in the two anesthesia groups. ConclusionPostoperative pain with WALANT technique or general anesthesia was comparable. Time spent in the operating room and in recovery room was significantly shorter with WALANT technique. Level of evidenceIII; prospective non-randomized comparative study.

WALANT surgery of the hand: state of the art.

Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25-1% lidocaine, with 1:100 000-1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.

Clinical and epidemiological evaluation of patients undergoing surgical treatment with local anesthesia using the walant technique

Clinical and epidemiological evaluation of patients undergoing surgical treatment with local anesthesia using the walant technique

The Outcome of the WALANT Technique in Primary Hand Flexor Tendons Repair

IntroductionWide-awake local anesthesia and no tourniquet (WALANT) represents a revolutionary technique for hand surgeons who dismiss tourniquets and sedation. In this study, we present our experience with the WALANT technique in primary flexor tendon injuries of the hand. Patient and methodsThis prospective research was carried out on 30 patients undergoing hand primary, flexor tendon repair surgery. Flexor tendon injury zones 2, 3, 4, and 5 were included. WALANT was prepared and injected. The tendons were surgically managed by a cruciate single cross-stitched locked 4-strand technique. The pain was assessed using a visual analog scale (VAS) score. The range of motion (ROM) of affected fingers was assessed according to the Strickland evaluation system. ResultsThere was a highly significant relationship between the patient's compliance with physiotherapy and obtained ROM of the affected finger with a P value <0.001. During injection of WALANT solution, 4 cases (13.3%) had no pain, 25 cases (83.3%) had mild pain (score 1–4), and 1 case (3.3%) had moderate pain (score 5–7). ConclusionWALANT provides an optimal bloodless and comfortable field with an opportunity to assess the strength of tendon repair, gapping or triggering and managing them intra-operatively.

Safety and efficacy of a modified WALANT technique using undiluted adrenaline during open surgical carpal tunnel release: a prospective report of 308 procedures

PurposeThe current study aimed to report on the safety and efficacy of utilizing a modified WALANT (mWALANT) technique during open surgical carpal tunnel release (CTR), where we used undiluted epinephrine compared to the originally described WALANT technique.MethodsFrom January 2015 till the end of June 2021, 200 patients (175 (87.5%) were females) who presented with carpal tunnel syndrome, either bilateral (108 (54%) patients) or unilateral (92 (46%)) were included, formulating a total of 308 procedures. Open surgical CTR was performed as a daycare procedure by the same surgeon. The mWALANT injectable mixture was prepared by mixing 8 CC of 2% lidocaine HCl + 1 CC of 0.25 mg/1 ml epinephrine without dilution (2.5 times the concentration used in the original WALANT technique). The injection was performed before draping.ResultsThe patients’ average age at surgery was 42.88 ± 13.03 years old; they were followed up for an average of 31 ± 17.17 months. The average operative time was 9.5 ± 1.87 min. None (0.0%) of the patients needed top-up of local anesthesia or shift into general anesthesia, and no (0.0%) patients needed postoperative hospital stay. The average VAS during the surgical procedure was 2.5 ± 2.1, mainly reported during infiltration of the local anesthesia; no patients reported discomfort during the surgical procedure itself. 180 (90%) patients reported a full return to their usual preoperative ADL after an average of 4.7 ± 1.2 weeks. No (0.0%) postoperative fingers ischemic or temperature changes. Two (1%) patients experienced an adrenaline rush in the form of tachycardia that needed sedation and close monitoring by the anesthesiologist; they were discharged on the same day. One (0.5%) patient (who had uncontrolled diabetes mellitus) showed a superficial wound infection which resolved after conservative management.ConclusionsUsing undiluted epinephrine during the mWALANT technique is safe and effective. There is no need to wait until the drugs fully function, and no epinephrine-related complications were encountered apart from occasional adrenaline rush symptoms.

Comparative Study, Walant vs Axillary Block in Carpal Tunnel Surgery

Objectives: Wide awake local anesthesia no tourniquet (WALANT) is a local anesthetic technique that, in theory, reduces costs and surgical waiting periods. The purpose of this study was to compare axillary block (AXB) with WALANT in terms of pain scores, duration of hospital stay, and hand function in patients who underwent CTR surgery. Methods: Between January 2015 and February 2020, a retrospective analysis was conducted on the outcomes of 410 patients who underwent CTS surgery. The Walant technique was utilized on 210 patients, while the AXB technique was utilized on 200 patients. These two groups were compared regarding operative time, hospital stay, VAS score at specific intervals before and after surgery, and hand function recovery. Results: The mean operation time is 11 min (8-18) for WALANT group and 13 min (7-43) for AXB group. Average time of length of hospitalization is 4.2 hours (2-6) for WALANT and 14.2 hours (9-26) for AXB groups. The VAS scores of WALANT group is significiantly less than AXB group (p&lt;0.05). The percentages of being able to use their hands compared to their nonoperative hands were evaluated. These rates were higher in the WALANT group than in the AXB group (65-75% vs. 45-60%). Conclusion: Increased patient comfort was associated with the WALANT technique. It is superior to AXB in terms of patient satisfaction, postoperative long-term pain management, and hand function recovery. Assuming all safety recommendations are adhered to, WALANT is an alternative to tourniquets in CTS surgeries for obtaining a bloodless surgical field without the discomfort of tourniquet application.

Symptom Outcome of Walant Technique for Carpal Tunnel Release – A Prospective Study in the Tertiary Care Hospital, Nowshera

OBJECTIVES The study aims to determine the outcome of the WALANT technique for Carpal Tunnel Release CTR.METHODOLOGY A descriptive study was done in the Neurosurgery department at Qazi Hussain Ahmad Medical Complex, Nowshera, from 15th September 2020 to 15th March 2021. A total of 29 consecutive patients of carpal tunnel syndrome (CTS) were undergoing carpal tunnel release (CTR) under wide awake local anaesthesia no tourniquet (WALANT) technique, using a mixture of lidocaine and epinephrine for local anaesthesia, and the outcome was assessed for patient satisfaction by Boston Carpal Tunnel Questionnaire (BCTQ) (symptom severity scales (SSS)) at pre-operatively and six weeks postoperatively.RESULTSWide awake CTR was done in 29 patients; 86.2% were female and 13.8% male. The mean age was 47.3 years. The average time of return to daily activity was three weeks. No complications were noted, like wound infection and dehiscence. BCTQ symptom (BCTQ-S) score significantly improved at six weeks postoperatively. 86% significantly reduced the symptom severity score (SSS). Mean SSS improved from preoperative 3.2 points to 1.7 points postoperatively. There was a significant decrease in distal latencies (p &lt;0.01). CONCLUSIONWide awake surgery is an excellent technique with favourable outcomes and good satisfaction rates for CTR. The study shows that clinical symptoms resolve rapidly after CTR. Without the need for monitored anaesthesia, the cost could decrease dramatically.

Retrospective review on tenolysis after phalangeal fractures: A Hong Kong local center experience

Background/Purpose: This is a local retrospective review on the outcomes of tenolysis after phalangeal fracture. Methods: The clinical outcome of nine patients (mean age 51.9 years) with finger fractures and subsequent tenolysis performed were reviewed. Range of motion was evaluated. Results: Extensor tenolysis, capsulotomy with or without flexor tenolysis was performed at a mean of 8.2 months after hand fracture with fracture fixation done. The total active motion (TAM) improved from 121° preoperatively to 173° postoperatively ( p = 0.02). Significant improvement of motion was observed at the proximal interphalangeal joint ( p = 0.012). All patient's range of motion improved after surgery. Conclusion: The gain of motion of 52° is comparable to other series. Release of all pathological anatomy and aggressive mobilization may improve the result further. Tenolysis can provide an encouraging improvement of active motion for stiff finger after phalangeal fractures. Recent results using WALANT technique showed satisfactory outcome. Future study on WALANT technique may further consolidate its potential benefit.

Translated article] Percutaneous ultrasound-guided section of the transverse carpal ligament vs. open surgery for the surgical treatment of carpal tunnel syndrome (CTS)

Background and objectiveThe gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. ObjectiveTo analyse the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Material and methodProspective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anaesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. ResultsThe sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4–54.5). Percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p>0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. ConclusionsIn view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarisation with the ultrasound visualisation of the anatomical structures to be treated.

Successful Use of WALANT in Local and Regional Soft Tissue Flaps: A Case Series.

A retrospective review was performed. Twenty-one patients who underwent a local or regional soft tissue flap surgery using the WALANT technique from February 2, 2018 to February 25, 2022 were included in our analysis. Overall, one Louvre flap, two posterior tibial artery perforator propeller flaps, two reverse radial forearm flaps, two Quaba flaps, six cross finger flaps, one reverse homodigital island flap, three first dorsal metacarpal artery flaps, two thenar flaps, and two Moberg flaps were performed. Patients were followed up for an average of 11.9 ± 8.1 weeks. During this time, no postoperative complications occurred. All patients demonstrated appropriate healing at donor and recipient sites. Full range of motion was regained for all patients. WALANT is safe and effective for use in local and regional soft tissue flap surgery. Surgeons should consider this technique for more involved procedures such as flap surgery, as preliminary results demonstrate positive outcomes and potentially superior recovery for patients.

Sección del ligamento transverso del carpo de forma percutánea ecoguiada vs. cirugía abierta para el tratamiento quirúrgico del síndrome del túnel del carpo (STC)

Background and objectiveThe gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. ObjectiveTo analyze the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Material and methodProspective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. ResultsThe sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4-54.5). Percutaneous technique was performed anterograde using the Kemis® H3 scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p> 0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. ConclusionsIn view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarization with the ultrasound visualization of the anatomical structures to be treated.

Reconstructive Surgery in a Patient with High Radial Nerve Palsy Using the WALANT Technique

Summary:Tendon transfers can be tied too tight or too loose. Both impede good function after surgery. Performing tendon transfers without sedation and pain during the surgery and then watching the patient move the transfer have helped us adjust the tension more accurately. This method can be applied to complex transfers such as radial nerve palsy triple tendon transfers. We describe the technique and results of a triple tendon transfer using wide-awake local anesthesia no tourniquet in a patient with a high radial nerve palsy. This was a complex case of reconstruction after five operations at the level of the humerus. This left him with a pseudoarthrosis of the humerus and a complete radial nerve palsy. We performed tendon transfers of pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to extensor pollicis longus tendons. Eighteen months after the triple tendon transfer surgery for the radial nerve palsy, the patient has good extension of the fingers, wrist, and thumb. He can open and close the hand properly. He has excellent function and mobility allowing him to perform most activities in a manner that is practically normal. Wide-awake local anesthesia no tourniquet can be used safely and successfully in complex cases requiring triple radial nerve tendon transfers of pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to extensor pollicis longus tendons.

Patient Satisfaction in Forefoot Surgery Using Walant Technique

Patient Satisfaction in Forefoot Surgery Using Walant Technique

Wide-awake local anesthesia for open rotator cuff repair: A case report.

Introduction and importanceImproper treatment of rotator cuff tear might result in progression of tear and deterioration of patient function. The rotator cuff tear can be managed conservatively in most cases however surgical treatment is inevitable in persistent patients.Presentation of caseA 45-year-old woman presented to our clinic with shoulder pain and restricted range of motion following a fall from a height three months before the current presentation. Due to the lack of favorable response to conservative treatment and the fact that rotator cuff rupture was traumatic, she became a candidate for rotator cuff repair surgery. Due to financial issues and the patient's refusal of undergoing general anesthesia we considered the WALANT technique. Prior to surgery, we explained the whole procedure to the patient, referring to its pros and cons.Clinical discussionThe WALANT procedure is a relatively recent technique that has become widespread in orthopedic surgery in the past decade. The advantages of the WALANT technique are that it is simple, feasible, and safe and that the analgesic is adequate during the operation and for the first few hours afterward (5). Concerns with this method include patient discomfort and pain during surgery, which can be managed by educating the patient and minute-by-minute explanation during the procedure.ConclusionWe advocate open rotator cuff repair with the WALANT approach as an effective, cost-saving, safe, simple, and quick alternative to general and regional anesthesia for certain patients or with limited anesthetic resources.Level of evidenceV

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

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

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.

Description of Walant Technique on Achilles Surgery in Times of Covid-19

Description of Walant Technique on Achilles Surgery in Times of Covid-19

Use of the WALANT technique for the surgical treatment of carpal tunnel syndrome: literature review

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.