Late-Onset Digital Ischaemia after WALANT: Successful Reversal with Off-Label Urapidil

Area of Science:

• Hand Surgery
• Pharmacology
• Vascular Complications

Background:

• Wide Awake Local Anaesthesia No Tourniquet (WALANT) has transformed hand surgery by avoiding sedation and tourniquets.
• While epinephrine is generally safe in WALANT, rare ischemic complications can occur.

Purpose of the Study:

• To report a case of delayed-onset digital ischemia following WALANT.
• To evaluate urapidil as an alternative treatment for epinephrine-induced vasospasm.

Main Methods:

• A 74-year-old woman developed digital ischemia post-WALANT surgery for Dupuytren's nodule.
• Phentolamine was unavailable; local urapidil infiltration was administered.

Main Results:

• Urapidil rapidly restored perfusion and sensation in the affected digit.
• The patient experienced a full recovery without any lasting sequelae.

Conclusions:

• Delayed-onset digital ischemia is a rare but serious complication of WALANT.
• Urapidil presents a safe and effective alternative to phentolamine for managing epinephrine-induced vasospasm.