The Brazilian Perspective of WALANT in Fracture Fixation From the Hand to the Elbow

The wide-awake local anesthesia no tourniquet (WALANT) technique is currently being used by several hand surgeons. This technique enables surgeries to be performed with the patient fully awake and without a tourniquet, thus allowing the intraoperative assessment of function. The purpose of this article was to describe our WALANT techniques for metacarpal, scaphoid, distal radius, radial head, and olecranon fracture fixation with its pearls and pitfalls. The authors demonstrate their infiltration technique, detailing how to perform it using lidocaine with 1:100,000 epinephrine and 8.4% sodium bicarbonate. The authors describe where to start the tumescent anesthesia in each type of fracture described. To achieve a painless surgery under WALANT, it is crucial to administer the subcutaneous anesthetic injection around the incision site and at the periosteum to surround the entire fractured bone circumferentially. Before making the incision, the fracture site must be manipulated and the patient should not experience any pain. As a routine in every WALANT procedure, we wait at least 25 minutes to start the surgery, as this is the optimal time interval to achieve maximal vasoconstriction within the limits of tumescent anesthesia. In all operated cases, it was possible to conduct intraoperative assessment of the range of motion of the elbow, wrist, hand, and fingers, in addition to evaluating the fixation stability through active motion and ensuring earlier rehabilitation.