Wide-awake Local Anesthesia Research Articles

Technique of Wide-Awake Local Anesthesia No Tourniquet Injection for a Transradial Forearm Amputation in an Ischemic Hand

A 48-year-old man with drug addiction presented with gangrene of the right hand following an inadvertent intra-arterial administration of crushed dihydrocodeine tartrate (DF 118) tablets (GlaxoSmithKline S.A.) dissolved in water; the solution was injected into his right antecubital fossa. After 3 weeks of pain, paresthesia, and cyanosis, his right hand became gangrenous. We performed a right forearm amputation by use of the wide-awake local anesthesia no tourniquet technique. After surgery, his wound healed well, and he was successfully fitted with a hand prosthesis.

Usefulness of Wide-Awake Local Anesthesia No Tourniquet Surgery to Decide on Tendon Transfer Versus Grafting in Chronic Flexor Tendon Rupture

We investigated the clinical outcomes of flexor tendon reconstruction for chronic rupture of the flexor tendon based on an evaluation of the voluntary active contraction distance (ACD) of the ruptured musculotendinous unit and changes in intraoperative total active motion (TAM) that could only be observed during wide-awake local anesthesia no tourniquet (WALANT) surgery. Reconstructions of 19 tendons of the flexor pollicis longus (FPL) and 18 tendons of the flexor digitorum profundus (FDP) were performed during WALANT surgery to evaluate the ACD of the ruptured musculotendinous unit and TAM observed during the surgery. Tendon grafting or tendon transfer was selected during the surgery based on ACD. TAM, pinch strength, and grip power were evaluated before the surgery, during the surgery, and at final follow-up, and they were surveyed based on Quick Disabilities of the Arm, Shoulder, and Hand (q-DASH) scores. The final outcomes of tendon grafting and tendon transfer were compared. In FPL tendon reconstruction, tendon grafting was performed in 10 patients with a total PDD and ACD value greater than 30 mm, and tendon transfer was performed in 9 patients with the value less than 30 mm. In FDP tendon reconstruction, tendon grafting was performed in 8 patients and tendon repair in 2 patients with a total PDD and ACD value greater than 40 mm, and tendon transfer was performed in 8 patients with the value less than 40 mm. The TAM value, q-DASH score, pinch power, and grip strength were improved in all patients. In both the tendon reconstructions, intraoperative TAM was significantly increased compared with preoperative TAM but significantly decreased at final follow-up. No significant differences were identified in final follow-up TAM and the q-DASH scores between tendon transfer and tendon grafting. The great advantage of WALANT surgery is that surgeons can evaluate the ruptured musculotendinous unit and measure TAM during the surgery. Therapeutic I.

Triggering Thumb Is Not Always a Trigger Thumb

Although rare, the thumb can trigger because of de Quervain disease. An 18-year-old woman presented with painful triggering during thumb movements. Physical examination revealed locking upon thumb extension and painful snapping upon thumb flexion, with tenderness over the first extensor compartment. During the ultrasonography examination, the extensor pollicis brevis tendon snapped with a jerky movement. According to intraoperative active movement under wide-awake local anesthesia no tourniquet, only the extensor pollicis brevis tendon subcompartment was released, and the snapping was resolved. The patient was symptom-free at the second postoperative week control. Triggering because of de Quervain tenosynovitis is a rare condition, and surgical release is required in most cases. Dynamic ultrasonography is an effective tool for precise preoperative assessment of pathology and assists surgical planning. Surgery under wide-awake local anesthesia no tourniquet is advised, which helps intraoperative assessment of pathology and ensures accurate treatment.

Office-Based Intraosseous Infiltrations of PRGF in Knee Osteoarthritis: Description of Technique

Knee osteoarthritis is a low-degree inflammatory condition that involves the whole synovial joint tissues as an organ. Recently, a biological approach using plasma rich in growth factors (PRGF) to tackle not only the synovial joint with intraarticular injections of PRGF, but also the subchondral bone with intraosseous infiltrations has been implemented with promising results. However, this procedure requires sedation, which limits the implementation of the procedure to operating room. We propose a modified and less cumbersome PRGF intraosseous infiltration approach for moderate and severe knee osteoarthritis, conducting the procedure in the ambulatory setting assisted with WALANT (wide-awake local anesthesia no tourniquet) technique. The proposed technique with a minimally invasive local anesthesia involves subcutaneous infiltration of lidocaine and epinephrine in a solution without sedation, and using ultrasound guidance, thereby streamlining the original procedure. This procedure is both a cost-effective and safe approach that may contribute to the widespread use of intraosseous infiltrations.

WALANT Technique in Percutaneous Scaphoid Osteosynthesis.

Scaphoid fractures account for 50 to 70% of all carpal bone fractures. Percutaneous scaphoid osteosynthesis can use the dorsal or volar approach, both with good results, and is most commonly performed under general anesthesia or regional nerve block. The wide-awake local anesthesia no tourniquet (WALANT) technique is already considered a safe and cost-effective technique in hand surgery around the world. Local anesthesia with epinephrine causes vasoconstriction, which obviates the need for tourniquet and, consequently, the need to use patient sedation. Thus, the possibility of testing fixation stability under physiological forces is another great advantage of using local anesthesia. In the technique described in the present paper, active wrist and hand motion can be tested immediately after scaphoid fixation. Wide-awake local anesthesia no tourniquet has been increasingly used in soft-tissue hand surgery and in the fixation of metacarpal and phalangeal fractures. However, to date, there is no published literature addressing the use of this technique in percutaneous scaphoid osteosynthesis. The purpose of the present technical note is to describe the use of WALANT for both the dorsal and volar approaches in percutaneous scaphoid osteosynthesis.

Percutaneous Ultrasound-Guided Release of the Lacertus Fibrosus for Median Nerve Entrapment at the Elbow.

The aim of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for pronator syndrome, i.e., entrapment of the median nerve at the elbow. Fifteen consecutive patients were included. Patients showed isolated pronator syndrome including pain plus reduced strength of specific median nerve innervated muscles. The release was performed in a non-operating interventional room under wide-awake local anesthesia no tourniquet (WALANT). It was conducted superficial to the pronator teres with in-plane ultrasound guidance. The recovery of strength was first assessed peroperatively, and then systematic visits at postoperative weeks 1 and 4 included assessments of both strength and pain. Procedures were comfortably completed with no immediate surgical or anesthetic complication. Muscle strength returned immediately and persisted at postoperative visits. Visual analog scores for pain reduced from 6.2 to 2.5 and 0.6 at weeks 1 and 4, respectively. All working patients were able to perform in their professional activities at week 1. The millimetric skin incision healed with no hypertrophic scar tissue. A small hematoma occurred at week 1 and resorbed spontaneously. No other delayed complication was observed. The procedure appeared effective with improved invasiveness compared to existing techniques. Real-time monitoring with ultrasound may improve the safety. The technique could be regarded as a new ultrasound-guided alternative to surgery. Performed superficial to the pronator teres muscle under WALANT anesthesia, the microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus may be an effective treatment of pronator syndrome.

Ten Questions About Wide Awake Local Anaesthesia No Tourniquet (WALANT) Surgery.

The aim of this review article is to provide many important tips and tricks for surgeons to start Wide Awake Local Anaesthesia No Tourniquet (WALANT) hand surgery in their practice. The massive cost reduction of this disruptive new approach will enable them to increase access to hand surgery for their patients who cannot afford unnecessary sedation or unnecessary sterility of the expensive main operating room environment. Evidence-based sterility will permit surgeons to move a lot of their surgery out of the main operating room to minor procedure rooms without a significant increase in infection rates. Important pointers on how to inject minimally painful local anaesthesia will have patients thinking the surgeon injector is a bit of a magician. WALANT enables surgeons to improve the outcomes of many hand surgery procedures. Level of Evidence: Level V (Therapeutic).

Comparison of infraclavicular brachial plexus block versus wide-awake local anesthesia no-tourniquet technique in the management of radial shortening osteotomy.

Objectives The aim of this study was to evaluate the feasibility of the wide-awake local anesthesia no-tourniquet (WALANT) technique in radial shortening osteotomy and to compare it with the infraclavicular brachial plexus block (IBPB).Patients and methods Between January 2020 and January 2021, a total of 26 patients (16 males, 10 females, mean age: 40±4.9 years; range, 29 to 45 years) with Kienbock’s disease who underwent radial shortening osteotomy were retrospectively analyzed. The patients were divided into two groups according to the type of anesthesia as WALANT (Group 1, n=11) and IBPB (Group 2, n=15) anesthesia. Visual Analog Scale (VAS) during surgery, time from anesthesia to surgical incision, surgical time, overall patient satisfaction regarding the anesthesia was assessed. The Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and handgrip strengths were compared at the final follow-up and short-term outcomes were analyzed.Results Age (p=0.896), sex (p=1.000), and dominant side involvement (p=1.000) were similar between the groups. Waiting time to start surgery in both groups was similar (27 vs. 25 min; p=0.053). Intraoperative VAS-pain scores and the satisfaction from the anesthesia type of both groups were also similar (p=0.546 and p=0.500).Conclusion The WALANT may be another anesthesia technique for radial shortening osteotomy with favorable outcomes. This technique adequately allows the surgeon to perform osteotomy and obtain a stable reduction without undue risk of tourniquet pain and palsy.

Safety and Clinical Outcome After Carpal Tunnel Release by A Special Instrument

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity. Surgical treatment by carpal tunnel release is needed after unsuccessful conservative treatment. However, complications such as neurovascular injury and incomplete release of the transverse carpal ligament may occur. Therefore, the authors developed a specially designed instrument for carpal tunnel release surgery, called a CTR knife 1, to avoid such complications. Objective: To demonstrate the safety and clinical outcomes of CTR knife 1. Materials and Methods: A descriptive study of 36 patients diagnosed with moderate to severe CTS by electrodiagnosis that underwent carpal tunnel release surgery were included in the present study. The technique for carpal tunnel release made use of the CTR knife 1 to cut the transverse carpal ligament by limited palmar incision. The wide-awake local anesthesia with no tourniquet technique was used in all subjects. The Clinical outcomes were evaluated by the symptom severity score and functional severity score of the Thai version of the Boston questionnaire. The outcomes were collected preoperatively and 1, 3, and 6 months postoperatively. Results: A significant decrease in both the symptom severity score and functional severity score postoperatively was observed. No life-threatening or serious complications such as permanent median nerve injury, tendon rupture, or infection were observed in the present study. Only two patients (5.6%) reported an unaesthetic scar, and one patient (2.8%) reported a painful scar that subsided after one year. Conclusion: The newly designed CTR knife 1 can be used as a surgical instrument in CTR because it is safe and effective for carpal tunnel release. Keywords: Carpal tunnel release; CTR knife; Carpal tunnel syndrome; Limited palmar incision; Limited open carpal tunnel release

Application of wide-awake local anesthesia no tourniquet technique in the treatment of acute Achilles tendon rupture

To explore the value of wide-awake local anesthesia no tourniquet (WALANT) technique in the treatment of acute Achilles tendon rupture. In a prospective randomized controlled trial, 48 patients with acute Achilles tendon rupture who met the criteria between March 2020 and October 2020 were randomly divided into two groups according to 1∶1 distribution, with 24 cases in each group. The study group used WALANT technique and the control group used epidural anesthesia with tourniquet for channel-assisted minimally invasive repair (CAMIR). There was no significant difference between the two groups in gender, age, injured side, cause of injury, distance from broken end of Achilles tendon to calcaneal tubercle, and time from injury to hospitalization ( P>0.05). The operating room use time (from patients entering the operating room to leaving the operating room), intraoperative blood loss, hospital stay, and the highest pain score [using Numerical Rating Scale (NRS)] during operation and at 1 day after operation were recorded and compared between the two groups. The tourniquet adverse reactions in the control group were recorded. The functional recovery was evaluated by the scoring method of American Orthopedic Foot and Ankle Society (AOFAS) at 12 months after operation. The operation was successfully completed in both groups. The operating room use time and hospital stay in the study group were significantly less than those in the control group ( P<0.05), but the difference in the intraoperative blood loss between the two groups was not significant ( t=0.429, P=0.670). There was no significant difference in the highest NRS score during operation between the two groups ( t=1.671, P=0.101); the highest NRS score in the study group at 1 day after operation was significantly lower than that in the control group ( t=-6.384, P<0.001). In the control group, 13 patients had different degrees of tourniquet adverse reactions, including tourniquet regional pain, local swelling, blisters, thigh numbness, and discomfort. The patients in both groups were followed up 12-18 months, with an average of 13.9 months. The motor function of all patients returned to normal at 12 months after operation. The difference in AOFAS scores between the two groups was not significant ( t=0.345, P=0.731). There was no complication such as sural nerve injury, local infection, and secondary rupture in both groups. The application of WALANT combined with CAMIR technique in the treatment of acute Achilles tendon rupture has good anesthetic and effectiveness, avoids the adverse reactions of tourniquet, and reasonably saves social medical resources.

Wide-Awake Hand Surgery Experience in Patients 10 to 18 Years of Age

We investigated the frequency of wide-awake local anesthesia no tourniquet (WALANT) use for hand surgery in the a 10- to 18-year-old age group and patients' experiences. Patients aged 10-18 years who had hand surgery in June 2016 to March 2020 were identified. The frequency of patients who agreed to have surgery under WALANT was calculated (%). Patients who received WALANT over the previous year were interviewed for their surgical experiences. A total of 69 patients were identified, and 46 of them received WALANT. The mean age was 14.5 ± 2 years, and 22 of them were boys. Sixteen patients were called for a surgical experience assessment via questionnaire. They reported pain less than 1/10 during anesthesia injection and surgery. Ten patients (62%) found their operation easy, and 14 (87.5%) would prefer WALANT again. This study showed that most patients in the 10-18 years age group accepted WALANT, and their surgical experiences were positive. For its advantages, WALANT should be considered in hand surgery for compliant patients in this age group. Therapeutic III.

Application of WALANT in Diaphyseal Plating of Forearm Fractures: An Observational Study

Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a novel anesthesia technique in distal radius and ankle fracture fixation. However, to date, there are limited studies in diaphyseal plating of forearm fractures under WALANT. This research is to study the feasibility of the use of WALANT technique in plating of diaphyseal fractures of the forearm as well as peri-operative outcomes. Sixty-one adult patients who underwent diaphyseal plating of the forearm under WALANT between the period of January 2019 and January 2021. It consists of 31 radius fractures, 15 ulna fractures and 15 ipsilateral radius and ulna fractures. Outcomes evaluated were duration of stay, peri-operative numerical pain rating scale, peri-operative blood pressure and heart rate, visual analogue scale for anxiety, blood loss, surgery duration, adverse effect, patient's satisfaction and any complications at 6 months follow up. Fifty-four patients (88.5%) were male and 7 patients (11.5%) were female with a mean age of 31.7 years (SD = 13.564). Thirty-eight out of 61 patients were totally pain free throughout the surgery. Ten (13%) patients reported pain during muscle dissection, 14 (18%) patients reported pain during bone manipulation and 12 (16%) patients reported pain during bone drilling. There was no significant difference in pain score between radius and ulna bones (P > .05). There was a significant change in blood pressure after LA infiltration (P < .01). The mean estimated blood loss was 27.39 ml (SD = 11.44) and the mean duration of post-surgery hospital stay was 1 day (SD = 1.026). Fifty-six patients (92%) recommended diaphyseal plating of the forearm under WALANT. None of the patients required conversion to general anesthesia and had any adverse events or infection during 6 months follow up. Diaphyseal plating of the forearm under WALANT is a feasible alternative anesthesia technique and is well tolerated by patients. Therapeutic III.

Wide-Awake Olecranon Tension Band Wiring with Ipsilateral Zone 6 Extensor Tendon Repair: A Case Report

Wide-awake local anaesthesia, no tourniquet (WALANT) continues to gain popularity and has been adapted for various fracture fixations proximal to the hand. A case of olecranon tension band wiring with concomitant extensor tendon repair is presented. The procedure was done with the patient awake in a lateral decubitus position 30min after the injection of WALANT solution at the intended surgical sites. Pain and discomfort were felt by the patient towards the end of the procedure mainly on his volar forearm where the bolster was placed. Olecranon fixation under WALANT is a viable alternative for patients who prefer to be awake or those with contraindications to general or regional anaesthesia. Alternative patient positioning may be considered, and perioperative pain control should not be overlooked.

A Study of Hand Flap Viability when Using a Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique

Objectives Flap surgery using a wide awake local anesthesia no tourniquet (WALANT) technique has historically been avoided because of technical challenges and concerns regarding the vasoconstriction caused by the necessary injection of epinephrine alongside the local anesthetic. The objective of our work was to evaluate the viability of the hand flaps performed using a WALANT technique compared with those performed under regional with a tourniquet.Materials and Methods Seventy-four patients were enrolled in a prospective comparative single-center study and subsequently divided into two groups: 36 patients in the locoregional anesthesia group and 38 patients in the WALANT group. Flap viability was evaluated on day 2 and day 10 using predetermined criteria.Results We did not find any significant difference in outcomes assessed for flap viability between the two groups postoperatively.Conclusion There was no evidence to suggest that vascularization of the flaps was compromised by the injection of epinephrine. The WALANT technique may, therefore, potentially be able to be safely deployed within this population.

Less Fluctuation in Hemodynamics of the Wide-Awake Local Anesthesia No Tourniquet Technique Than General Anesthesia in Distal Radius Plating Surgery: A Prospective Case-Control Study.

This prospective case-control study aimed to compare the intraoperative hemodynamic changes between the wide-awake local anesthesia no tourniquet (WALANT) technique and general anesthesia (GA) in patients undergoing distal radius plating surgery. Forty adults with distal radius fractures underwent plating surgery via the WALANT technique (20 patients) or GA (20 patients). Mean arterial pressure (MAP) and heart rate were recorded. Intraoperative pain intensity was measured using the visual analog scale (VAS) for pain in the WALANT group. The measures of hemodynamics and VAS were recorded at seven-time points perioperatively. The VAS score decreased significantly compared with the preoperative status in the WALANT group for most of the intraoperative period except during injections of local anesthetics and fracture reduction. The intraoperative MAP in the WALANT group showed no significant change during the perioperative period. In addition, the WALANT group showed fewer perioperative MAP fluctuations than the GA group (p < 0.05). The reduction and plating quality were similar between the two groups. WALANT provided a feasible technique with less fluctuation in hemodynamic status. With gentle manipulation of the fracture reduction, distal radius plating surgery using the WALANT technique is a well-tolerated surgical procedure and shows similar reduction and plating quality to GA.

WALANT – Wide Awake Local Anaesthesia No Tourniquet: Komplikationen bei elektiven und akut-traumatologischen handchirurgischen Eingriffen

The WALANT (Wide Awake Local Anaesthesia No Tourniquet) technique has rapidly gained popularity. The advantages are often described, whereas information about complications is rare. Therefore, we followed up on our own patients regarding complications.Patients and Method Between January 2013 und June 2017, the complications experienced by one single surgeon were evaluated. The study included all elective (n = 195) and acute (n = 90) surgical procedures performed in WALANT. Minimum age of the patients was 18 years. All patients received Articaine 1 % and Suprarenine (1:200.000). Different volumes were injected with a minimum delay to surgery of 30 minutes. Complications were identified retrospectively by evaluation of patient files and a survey via telephone using a standardised questionnaire. Mean follow-up was 73 weeks. In 285 patients, there were 13 (4.6 %) complications. After injection of 16 ml of Articaine/Suprarenine, one patient had coronary symptoms, which ceased when two puffs of nitroglycerin spray were given. In one patient with a neurovascular injury in the palm, a bloodless field could not be obtained. A short tourniquet time was necessary for exploration. In one patient undergoing flexor tendon tenolysis, there was a need to convert to general anaesthesia with tourniquet because there was insufficient vasoconstriction due to marked scar tissue. One patient had an erythema around the injection site for a prolonged time, two had extensive erythema on the dorsum of the hand and seven patients reported swelling of the hand that lasted more than one week. The WALANT method is safe. Perioperative complications are rare. Nevertheless, there are some disadvantages that should be considered.Vascular injuries, especially in fingers, are to be monitored closely regarding perfusion, and the off-label use should be remembered. Also, caution should be exercised in patients with cardiac disease. Larger injuries may need a short tourniquet time. Tissue that was operated on before does not always seem to be suitable for the technique as diffusion may be compromised. In rare cases, patients may suffer from prolonged erythema or swelling. Generally, patients should be evaluated for suitability to an operation in local anaesthesia.

WALANT in hand surgery: Ischemic complications and their medicolegal implications in France: A systematic review of the literature and of French legal databases

WALANT (Wide Awake Local Anesthesia No Tourniquet) presents a theoretical risk of digital ischemia due to the presence of epinephrine, associated to the local anesthetic. For this reason, in France, the market authorization prohibits the use of epinephrine in digital extremities. The main objective of the present study was to assess the risk of ischemic complications reported in literature, and then to analyze the medicolegal implications in France. A systematic literature review was performed by three independent readers, using the PubMed and Embase databases. Also, declarations of claims and legal proceedings between 2007 and 2020 in France were examined in the official national Légifrance and Doctrine databases. Eight of the 424 articles retrieved were selected. Only 3 cases of digital necrosis following local anesthesia with adrenalized lidocaine were reported. Adrenalized xylocaine may be considered in case of peripheral microcirculation disorder. From a medicolegal point of view, no complaints or medicolegal implications were associated with WALANT in France. It seems that the market authorization for adrenalized local anesthesia could be extended to use in the digital extremities. However, the lack of medical and legal data calls for caution. We therefore recommend the use of an institutional protocol specifying the cases of overdose and the patient's pathway, and training for practitioners wishing to use this technique.

The Impact of Intraoperative Nursing Care on Perioperative Complications During Wide-Awake Local Anesthesia Hand Surgery

The wide-awake local anesthesia technique in hand surgery is widely used, but there are currently no guidelines or protocols for the number of operating room personnel required to optimize patient safety intraoperatively. This study aimed to evaluate perioperative complication rates of wide-awake local anesthesia hand surgeries performed at surgery centers that used different numbers of operating room nurses. We conducted a retrospective review of patients who underwent wide-awake local anesthesia hand surgery at 4 surgical centers over a 30-month consecutive period. Two surgical centers used 3 operating room nurses, and 2 centers used 2 operating room nurses. The complications reported included intraoperative case abortion because of critical change in patient vitals, intraoperative medication delivery, intraoperative intravenous placement for medication delivery, intraoperative conversion to sedation, intraoperative medical complications, and postoperative transfer to the emergency department or a hospital. A total of 1,771 wide-awake local anesthesia surgical procedures were identified, with 925 performed at a facility that used 2 operating room nurses and 846 performed at a facility that used 3 operating room nurses. There were no perioperative complications in either group during the study period. There was no difference in perioperative complications between the surgery centers that used 3 versus 2 intraoperative nurses during wide-awake local anesthesia hand surgery. This study supports that limiting the nursing personnel for wide-awake local anesthesia hand surgeries could be an efficient way to cut procedural costs without compromising patient safety. Therapeutic IV.

Functional Outcomes of Flexor Tendon Repair in the Fingers: A Comparison of Wide-Awake Local Anesthesia No Tourniquet Versus Traditional Anesthesia.

Flexor tendon lacerations in the fingers are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA. All patients who underwent a primary flexor tendon repair in zone I and II without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations. Sixty-five zone I (N = 21) or II (N = 44) flexor tendon repairs were included in the final analysis: 23 WALANT and 42 TA. There were no statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the groups. The final Quick Disabilities of the Arm, Shoulder, and Hand score in the WALANT group was 17.2 (SD: 14.4) versus 23.3 (SD: 18.5) in the TA group. There were no statistical differences between the groups with any final range of motion (ROM) parameters, grip strength, or Visual Analog Scale pain scores at the final follow-up. The WALANT group was found to have a slightly higher reoperation rate (26.1% vs 7.1%; P = .034) than the TA group. This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under WALANT. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.

The what, why and when of wide awake local anaesthesia no tourniquet surgery.

Wide awake local anaesthesia no tourniquet, also known as WALANT, is the practice of performing surgery under local anaesthetic in the absence of a tourniquet. This technique uses the vasoconstrictive effects of adrenaline and the local anaesthetic effects of lignocaine to establish a Bier block with haemostatic control. Permitting active patient participation intraoperatively, wide awake local anaesthesia no tourniquet surgery improves patient compliance with rehabilitation and yields higher patient satisfaction. With reduced cost and equipment requirements, this method improves accessibility for patients and productivity for healthcare institutions. This is of particular benefit within the current COVID-19 climate, as wide awake local anaesthesia no tourniquet technique provides a means of overcoming restrictions to theatre access and anaesthetic support. This review delves into the current uses of wide awake local anaesthesia no tourniquet surgery, outlining the initial conception of the practice by Canadian surgeons. The advantages and disadvantages are considered, and potential future applications of this technique are discussed.