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WALANT, Covid-19, Hand trauma, Non-tourniquet
Background and aim WALANT procedures are becoming more popular, and are particularly useful in the COVID-19 pandemic. Procedures can be performed without needing access to general theatres and anaesthetic support, minimising the number of patient-healthcare interactions and avoiding aerosolisation.
Our unit has taken this approach and aim to present a case series that demonstrates the efficacy and safety of WALANT.
Methods A prospective analysis of WALANT cases in a single plastic surgery centre during March-August 2020 was performed. All procedures using a WALANT approach were included, that would have otherwise required general anaesthetic or regional block. Data was collected on a number of variables, including patient satisfaction.
Results: 37 procedures were included in analysis. The majority of the injuries consisted of hand trauma. There were no cases of post-operative complications, although one required completion in main theatres due to technicality. No patients required additional anaesthetic during the procedure and all reported pain score as 0/10. Overall patient satisfaction was 10/10 for 26 patients, 9/10 for 10 patients and 7/10 for one patient.
Conclusions Results show the use of WALANT can facilitate an effective plastic surgery trauma service during COVID-19. Most of the procedures were performed in the outpatient department setting, without the need for main operating theatres or anaesthetic support. All procedures were performed within 24 hours of initial presentation and were able to be discharged on the same day. In addition, patient satisfaction remained high and post-operative complications were minimal. We propose that the use of WALANT should continue and increase beyond the current pandemic.
 Leblanc MR, Lalonde DH, Thoma A, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand. 2011;6:60-63
 Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review
 Caggiano NM, Avery DM, Matullo KS. The effect of anesthesia type on nonsurgical operating room time. J Hand Surg Am. 2015;40:1202-1209.e1.
 Tumescent Local Anesthesia for Hand Surgery: Improved Results, Cost Effectiveness, and Wide-Awake Patient Satisfaction
 An Economic Analysis of MAC Versus WALANT: A Trigger Finger Release Surgery Case Study
Jason L. Codding,
 Comparison of the Wide-Awake Approach and Conventional Approach in Extensor Indicis Proprius-to-Extensor Pollicis Longus Tendon Transfer for Chronic Extensor Pollicis Longus Rupture Jung-Jun Hong, M.D.
 Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis Ted Matthew P. Evangelista
 Minimally Invasive Finger Fracture Management: Wide-awake Closed Reduction, K-wire Fixation, and Early Protected Movement. Gregory BHK
 Patients’ Perspective on Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia
 Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet
 . Iqbal HJ, Doorgakant A, Rehmatullah NNT, Ramavath AL, Pidikiti P, Lipscombe S. Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial. JHSE 2018;43(8):808–12.
 A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline Mohd Zaim Mohd Rashid,
 A Cost Analysis of Carpal Tunnel Release Surgery Performed Wide Awake versus under Sedation
 Comparison of Postoperative Complications Associated With Anesthetic Choice for Surgery of the Hand
Joshua W. Hustedt, MD, MHS
 Higgins A, Lalonde DH, Bell M, et al. Avoiding flexor tendon repair rupture with intraoperative total active movement examination. Plast Reconstr Surg 2010; 126(3):941. 13.
 Lalonde DH, Kozin S. Tendon disorders of the hand. Plast Reconstr Surg 2011;128(1):1e–14e. 14.
 Lalonde DH. Wide-awake flexor tendon repair. Plast Reconstr Surg 2009;123(2):623.