Wide-awake surgery in orthopaedics: "Scoping review"

Area of Science:

• Orthopaedic Surgery
• Traumatology
• Anesthesiology

Background:

• Wide awake local anaesthesia not tourniquet (WALANT) combines local anesthetic with a vasoconstrictor.
• This technique aims to reduce surgical bleeding and eliminate the need for pneumatic tourniquets.
• The common formula involves 1% lidocaine and 1:100,000 epinephrine.

Purpose of the Study:

• To conduct a comprehensive literature review of the WALANT anesthetic modality.
• Focus on its application within orthopaedic surgery and traumatology.

Main Methods:

• Searches of PubMed and Embase databases were performed.
• Included experimental, observational comparative, descriptive (n>5), and cost studies.
• Two independent investigators conducted and combined the searches.

Main Results:

• 36 studies were included from 8794 entries, with most published after 2010.
• Studies predominantly focused on hand surgery with diverse indications.
• Significant heterogeneity was observed in study designs, variables, and WALANT technique definitions.

Conclusions:

• This is the first comprehensive review of the WALANT modality.
• Heterogeneity exists in study populations, comparators, and variables.
• A lack of precise methodological details for the WALANT technique was noted.