WALANT Hand Surgery Does Not Require Postoperative Opioid Pain Management.

Area of Science:

• Orthopedic Surgery
• Pain Management
• Anesthesiology

Background:

• Opioids are the standard for postoperative pain, but abuse is a concern.
• Minimizing opioid exposure is a key goal in patient care.

Purpose of the Study:

• To evaluate the effectiveness of the wide-awake, local anesthesia, no-tourniquet (WALANT) technique in reducing postoperative opioid use.
• To compare pain scores and opioid-seeking behavior in patients undergoing hand surgery with WALANT versus monitored anesthesia care.

Main Methods:

• Prospective cohort study of 94 hand/upper extremity surgical patients using the WALANT technique.
• Comparison with cohorts receiving monitored anesthesia care, with or without postoperative opioids.
• Pain scores (VAS) collected preoperatively and on postoperative days 1 and 14; opioid-seeking assessed via medical records and state monitoring program.

Main Results:

• WALANT patients reported significantly decreased pain 14 days postoperatively (mean VAS 0.37), lower than monitored anesthesia care groups.
• Only 2.1% of WALANT patients sought outside opioid prescriptions.
• Factors like sex, age, comorbidities, or prior opioid exposure did not significantly alter outcomes.

Conclusions:

• The WALANT technique is a viable option for hand surgeons to decrease postoperative opioid reliance.
• Adoption of WALANT can help mitigate opioid abuse risks in surgical patients.