Is WALANT Really Necessary in Outpatient Surgery?

Area of Science:

• Orthopedics
• Anesthesiology
• Hand Surgery

Background:

• The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique is widely used in outpatient hand surgery.
• WALANT offers benefits like patient cooperation but has limitations including a steep learning curve and potential risks like digital ischemia.
• This study investigates an alternative anesthetic approach for specific hand surgeries.

Purpose of the Study:

• To evaluate the safety and effectiveness of local anesthesia combined with a tourniquet for short-duration outpatient hand surgeries.
• To compare this technique with the WALANT method.
• To determine if local anesthesia with a tourniquet is a suitable alternative for procedures like carpal tunnel and trigger finger release.

Main Methods:

• A case series of 300 patients undergoing carpal tunnel or trigger finger release between February 2023 and March 2024.
• Patients received local anesthesia (lidocaine) with a proximal arm tourniquet.
• Data collected included demographics, operative time, and pain levels using the Visual Analog Scale (VAS).

Main Results:

• The average surgical time was 12 minutes, with most cases being carpal tunnel release.
• The mean VAS pain score was 3.73, with higher scores reported by older patients and in longer procedures.
• Tourniquet removal due to patient discomfort was infrequent, occurring in only 1% of cases.

Conclusions:

• Local anesthesia with a tourniquet is a safe and effective option for short outpatient hand surgeries.
• This technique presents a practical alternative to the WALANT technique.
• The findings suggest a need for personalized anesthetic strategies in hand surgery based on procedure duration and patient factors.