WALANT: Perceptions, approaches, and contraindications in a tertiary hand surgery unit

Area of Science:

• Plastic Surgery
• Hand Surgery
• Anesthesiology

Background:

• Wide awake local anesthetic no tourniquet (WALANT) is increasingly adopted for hand surgery.
• Digital adrenaline use is safe, despite historical concerns.
• Phentolamine can reverse potential digital ischemia from adrenaline.

Purpose of the Study:

• To assess hand surgeons' knowledge of adrenaline use in WALANT procedures.
• To identify knowledge gaps regarding adrenaline's onset, duration, and reversal.
• To advocate for a WALANT protocol to improve patient safety.

Main Methods:

• A survey was distributed to 40 specialist plastic and hand surgeons.
• The survey assessed understanding of WALANT, adrenaline effects, and phentolamine reversal.
• Data analysis focused on awareness of safety, onset, duration, and reversal protocols.

Main Results:

• 80% of surgeons recognized digital adrenaline safety.
• Awareness of adrenaline's full effect onset (65%) and duration (25%) was low.
• Only 50% knew phentolamine reverses adrenaline, and 20% knew the correct dose.

Conclusions:

• Significant knowledge gaps exist among hand surgeons regarding adrenaline use in WALANT.
• A standardized WALANT protocol with targeted education is necessary.
• Implementing a checklist-style protocol can mitigate risks and improve safety.