Fig 2 - available via license: CC BY-NC-ND
Content may be subject to copyright.
Intraoperative picture: No tourniquet was applied. after grinding and shaping of the socket, minimal bleeding was observed. 

Intraoperative picture: No tourniquet was applied. after grinding and shaping of the socket, minimal bleeding was observed. 

Source publication
Article
Full-text available
Wide awake local anesthesia no tourniquet (WALANT) hand surgery is a rapidly growing in popularity. WALANT has been used by hand surgeons when operating on bones, tendons, ligaments, nerve entrapments. We offer a case report of the first case in the literature describing WALANT technique when performing trapeziometacarpal joint arthroplasty with pr...

Context in source publication

Context 1
... of the TMC joint was performed, preserving capsule for closure. 17 With an oscillating saw, a thin slice of the dis- tal trapezium, enough to get a flat surface, and proximal metacarpal joint surface were excised. A tourniquet was not necessary, and visualization was excellent even when grinding and shaping of the socket in the trapezium (Fig. 2). After placement of the sizer prosthesis, we tested the fit, and the range of motion of the joint. The Kapand- ji test for thumb mobility was performed. 18 The Kapandji score assesses the opposition of the thumb, based on where on their hand the patient is able to touch with the tip of their thumb. A score 1 means their thumb touches ...

Similar publications

Preprint
Full-text available
Background : The purpose of this study is to illustrate whether the electro-cauterization and transient tourniquet enhanced efficiency of local anesthesia with epinephrine in surgery of metacarpal fractures. Methods : Forty-four consecutive cases of metacarpal fractures with estimated major operative time more than 30 minutes were enrolled. Local a...

Citations

... 41 Similarly positive analgesic results were reported with olecranon fracture plating, hand fracture fixation, 42 wrist arthroscopy for triangular fibrocartilaginous complex repair, 43 and trapeziometacarpal joint prosthesis implantation. [42][43][44] Repair of an ulna shaft fracture has also been performed under WALANT with the addition of a periosteal nerve block. 45 ...
Article
Full-text available
Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.
... WALANT has also been used for trapeziometacarpal joint prothesis implantation with no complications. 33 Additionally, Tang et al 34 and Xing and Tang 34 extended the use of the WALANT to flap harvesting and transfer in the hand. The authors reported successful execution of the extended Segmuller flap, the homodigital reverse digital artery flap, the dorsal metacarpal artery perforator flap, and the atasoy advancement flap on 27 patients using WALANT. ...
Article
Full-text available
The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT. Methods: A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety. Results: The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates. Conclusions: The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.
... In recent years, local anaesthesia has become popular and gained acceptance among hand surgeons from many countries (Gong and (Codding et al., 2017) to more complex procedures such as nerve transposition, tendon transfers (Lamouille et al., 2017) or trapeziometacarpal joint replacements (Müller et al., 2018). One of those techniques, also referred to as ''wide awake local anaesthesia no tourniquet'' (WALANT) (Lalonde, 2017), implies that the patient's anaesthesia is achieved by local injections by the surgeon, thus removing the need for an anaesthesiologist. ...
Article
PURPOSE : Recently, local anaesthesia has become popular among hand surgeons. We hypothesized that using the ‘’wide awake local anaesthesia, no tourniquet’’ (WALANT) approach would result in lower global costs and in an increase of the operating room's efficiency. METHODS : All cases of carpal tunnel and trigger finger releases performed over 2016 and 2017 were divided into four groups, following which anaesthesia method was used. Total operating room occupation time, surgical time and the ‘’all but surgery’’ time were analysed. A common minimal bill per anaesthesia was generated. RESULTS : WALANT or local anaesthesia & tourniquet increase the operating room's throughput by having shorter operation room occupation times than other methods (17.5-33%). Costs of the two procedures are reduced by 21-31% when using local anaesthesia methods. CONCLUSION : Preferring those techniques for carpal tunnel and trigger finger releases has a notable beneficial impact on the costs and on the operating room's efficiency. This effect is more evident on short surgical procedures. LOE : Level of evidence III, economic analysis.
... SR implant surgery has increased in popularity during the last decades. The surgery is relatively straight forward and can be done in wide-awake local anesthesia no tourniquet (WALANT) technique [27,28]. In this perspective, it is easy to forget or overlook old techniques such as perichondrium transplantation performed in general anesthesia. ...
Article
Full-text available
Background: The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Methods: We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint. Results: The median follow-up time was 6 years (0-21) for the SR implants and 26 years (1-37) for the perichondrium transplants. Median age at index surgery was 64 years (24-82) for SR implants and 45 years (18-61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4-100.0) than in the SR implant group (75%; CI 53.8-96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55-100) than in the SR implant group (74.7%; CI 66.6-82.7), but below the threshold of statistical significance (p = 0.8). Conclusion: In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants. Level of evidence: III (Therapeutic).
... Ide tartoznak a nagyobb csont-ízüle műtétek, például csukló arthrodesis, carpectomia stb. Megjegyzem, WALANT érzéstelenítéssel végze nyeregízüle arthroplas cáról, distalis orsócsont törés lemezes osteosynthesiséről már beszámoltak (5,12). ...
Article
Full-text available
Purpose 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. Methods 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. Results 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. Conclusions 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. Type of study/level of evidence Therapeutic III.
Article
Purpose Wide-Awake Local Anesthetic No Tourniquet (WALANT) hand surgery avoids many medical risks associated with traditional anesthesia options. However, patients may be hesitant to choose the WALANT approach because of concerns about being awake during surgery. The purpose of this study was to characterize patients’ thoughts and concerns about being awake during hand surgery and determine factors that may affect their decision about anesthesia options. Methods Qualitative interviews were conducted with 15 patients with a diagnosis of carpal tunnel syndrome, trigger finger, or De Quervain’s tenosynovitis who were receiving nonoperative care. Interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was used to identify themes, concerns, and potential intervention targets. Results Eight participants reported that patients have a general bias against being “knocked out,” 7 of whom described concerns of uncertainty about emerging from anesthesia. All participants would consider WALANT, with some reservations. Recurrent themes included ensuring they would not feel, see, or hear the surgery and a preference toward distractions, such as music or engaging conversation. Of 15 participants, 13 would not want to see the surgery. For patients who found WALANT appealing, they valued the decreased time investment compared to sedation and the avoidance of side effects or exacerbation of comorbidities. A recurring theme of trust between surgeon and patient arose when deciding about anesthesia type. Conclusions Most patients are open to WALANT, but have concerns of hearing the surgery or feeling pain. Potential interventions to address these concerns, beyond establishing a trusting physician-patient relationship, include music or video with headphones and confirming skin numbness prior to surgery. Clinical relevance This study provides insights into patients’ thought processes regarding WALANT hand surgery and give the surgeon talking points when counseling patients on their anesthesia type for hand surgery.
Article
Wide awake local anesthesia no tourniquet (WALANT) refers to an anesthesia technique with low bleeding and complication rates, which enables interventions on the hand in an awake patient without the use of a tourniquet. Bleeding control is achieved through addition of vasoconstrictors to the infiltration solution. Since the motor function of the extremity is not affected, it offers the additional possibility of intraoperative active function testing. The WALANT procedure constitutes an established, effective, easily learnt and resource-sparing technique. The spectrum of surgical possibilities with WALANT is wide and covers nearly all elective and many emergency procedures. Due to multiple advantages in contrast to other regional and general anesthesia procedures, WALANT features an increasing spectrum of surgical applications and practitioners. It is therefore of interest for hand surgeons working both in hospitals and private practices.
Article
We hypothesized that WALANT would provide similar perioperative analgesic comfort compared to local anesthesia with peripheral nerve blocks (LAPNV). We analyzed whether the patient’s active participation during surgery would improve its early functional results. We did a retrospective, single study in an outpatient surgery unit, comparing two types of surgery: trapeziometacarpal arthroplasty (TMCA) under LAPNV and TMCA under WALANT. Fifteen patients were included per group. Pain levels were determined during anesthesia induction, intraoperatively, postoperatively, at rest and during activity at the last follow-up visit. The overall satisfaction with the surgery and time to resume daily activities and work were documented. The statistical analysis was performed on SAS software with an ANOVA. The significance threshold was set at 0.05. The groups were comparable on age, sex, dominant side, and operated side. No patients were lost to follow-up. The mean follow-up was 4 months (2.3–11). The QuickDASH score was 4.93 for TMCA under WALANT vs. 13.47 for TMCA under LAPNV (p = 0.01). There was no loosening, dislocation, or major complication. Our study showed that TMCA performed with WALANT yields similar results to the same procedure with LAPNV for perioperative pain relief without additional complications. Functional scores seem to be slightly improved with WALANT compared to LAPNV, but these results should be confirmed with longer follow up.
Article
We conducted a descriptive study of 50 consecutive cases of total trapeziometacarpal joint arthroplasty by one surgeon using wide awake local anaesthetic no tourniquet to assess the usefulness and reliability of the anaesthesia, any adverse effects and patient acceptance. No difference was found when comparing the duration of surgery with 50 cases of total trapeziometacarpal joint arthroplasty inserted in a bloodless field under general or regional anaesthesia by the same surgeon. Wide awake local anaesthetic no tourniquet was found to be useful in providing adequate anaesthesia and haemostasis, and to be reliable and safe with no adverse effects. Patient satisfaction was high with 100% willing to repeat. Overall, wide awake local anaesthetic no tourniquet was a satisfactory method of anaesthesia for trapeziometacarpal joint arthroplasty with the potential for significant benefits to both patient and surgeon compared with traditional general anaesthesia and regional block. Level of evidence: II