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Janes L, Sepehripour S, Lalonde D. Clinically Important Pharmacologic Considerations for Wide-Awake Local Anesthesia No Tourniquet Hand Surgery. Plast Reconstr Surg 2024; 154:391e-402e. [PMID: 37220403 DOI: 10.1097/prs.0000000000010706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
SUMMARY Understanding the clinically important pharmacokinetics (what the body does to the drug) and pharmacodynamics (what the drug does to the body) of medications used in surgery will help surgeons use them more safely and effectively. The goal of this article is to provide an overview of these considerations for the 2 medications used in wide-awake local anesthesia with no tourniquet upper extremity surgery (ie, lidocaine and epinephrine) to establish a better understanding of lidocaine and epinephrine in tumescent local anesthesia, as well as adverse reactions and how to manage them.
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Affiliation(s)
- Lindsay Janes
- From the Department of Orthopaedic Surgery, University of Pennsylvania
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2
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Lalonde DH, Gruber MM, Ahmad AA, Langer MF, Sepehripour S. New Frontiers in Wide-Awake Surgery. Plast Reconstr Surg 2024; 153:1212e-1223e. [PMID: 38810165 DOI: 10.1097/prs.0000000000011414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Explain the most important benefits of wide-awake surgery to patients. 2. Tumesce large parts of the body with minimal pain local anesthesia injection technique to eliminate the need for sedation for many operations. 3. Apply tourniquet-free surgery to upper and lower limb operations to avoid the sedation required to tolerate tourniquet pain. 4. Move many procedures out of the main operating room to minor procedure rooms with no increase in infection rates to decrease unnecessary cost and solid waste in surgery. SUMMARY Three disruptive innovations are changing the landscape of surgery: (1) minimally painful injection of large-volume, low-concentration tumescent local anesthesia eliminates the need for sedation for many procedures over the entire body; (2) epinephrine vasoconstriction in tumescent local anesthesia is a good alternative to the tourniquet and proximal nerve blocks in extremity surgery (sedation for tourniquet pain is no longer required for many procedures); and (3) evidence-based sterility and the elimination of sedation enable many larger procedures to move out of the main operating room into minor procedure rooms with no increase in infection rates. This continuing medical education article explores some of the new frontiers in which these changes affect surgery all over the body.
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Affiliation(s)
| | | | | | - Martin F Langer
- the Clinic for Trauma, Hand, and Reconstructive Surgery, University Clinic Muenster
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Degreef I, Lalonde DH. WALANT surgery of the hand: state of the art. EFORT Open Rev 2024; 9:349-356. [PMID: 38726975 PMCID: PMC11099575 DOI: 10.1530/eor-24-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25-1% lidocaine, with 1:100 000-1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.
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Affiliation(s)
- Ilse Degreef
- Department of Orthopaedic, Hand Unit, Leuven University Hospitals, Gasthuisberg, Herestraat, Leuven, Belgium
| | - Donald H Lalonde
- Division of Plastic Surgery, Dalhousie University, Saint John, New Brunswick, Canada
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Pandya SM, Njuguna T, Maina C, Jani P, Lalonde D. Minimal Pain Tumescent Local Anesthesia Injection for Wide Awake Modified Radical Mastectomy. Plast Surg (Oakv) 2024; 32:357-359. [PMID: 38681242 PMCID: PMC11046268 DOI: 10.1177/22925503221120573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 05/01/2024] Open
Abstract
The advent of minimal pain tumescent local anesthesia injection has improved patient safety by eliminating the need for sedation for many wide awake operations, especially in patients with significant medical comorbidities. Modified radical mastectomy (MRM) for breast cancer is commonly performed under general anesthesia as it requires the dissection of the entire breast and an ipsilateral axillary lymph node dissection (ALND). General anesthesia has been shown to have a high risk in patients with severe medical comorbidities. We present a case of a 78-year-old male patient who was diagnosed with invasive ductal breast carcinoma, cardiac failure, and other metabolic abnormalities. Taking his comorbidities into account, we performed a wide awake MRM and ALND after tumescent minimal pain local anesthesia injection. The patient experienced the successful procedure safely with minimal discomfort.
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Affiliation(s)
| | | | - Carol Maina
- Nakuru County, Referral & Teaching Hospital, Nakuru, Kenya
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Conger JR, Manipud N, Elhalouti I, Lo C, Wang Y, Burnstine MA, Dresner SC, Samimi DB. Oral Sedation Anesthesia Protocol for In-Office Oculoplastic Surgery. Ophthalmic Plast Reconstr Surg 2024; 40:254-259. [PMID: 37972952 DOI: 10.1097/iop.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE To present an oral anesthesia protocol for in-office oculoplastic surgery and to compare safety outcomes and patient and physician experiences to ambulatory surgery center (ASC)-based surgery with intravenous sedation or general anesthesia. METHODS A prospective study was performed on consecutive patients undergoing surgery at an oculofacial plastic surgery practice. Surgery was performed in an in-office setting using our standardized oral sedation protocol or at an ASC with intravenous sedation or general anesthesia. Preoperative and postoperative surveys were conducted by patients and physicians to compare surgical experience, safety, and efficacy of our oral sedation protocol for in-office surgery in the ASC setting. RESULTS Two hundred and fifty-three patients (167 in-office and 86 at ASC) underwent surgery between March and November 2022. There was no significant difference in how patients or physicians rated their experience between the 2 locations. A significantly higher proportion of ASC patients would have rather had surgery in-office (34.9% vs. 19.2%; p = 0.006). A significantly higher number of physicians in the office setting would have rather performed surgery at the ASC than the reverse (12.7% vs. 2.3%, respectfully; p = 0.007). There were no safety complications reported in either setting. CONCLUSIONS Within our patient cohort, the presented oral sedation protocol provided safe and effective anesthesia for in-office oculoplastic surgery that is comparable to an ASC.
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Affiliation(s)
- Jordan R Conger
- Eyesthetica, Los Angeles, California, U.S.A
- Department of Ophthalmology, Los Angeles County, USC Medical Center, Roski Eye Institute, Los Angeles, California, U.S.A
| | | | | | | | - Yao Wang
- Eyesthetica, Los Angeles, California, U.S.A
| | - Michael A Burnstine
- Eyesthetica, Los Angeles, California, U.S.A
- Department of Ophthalmology, Los Angeles County, USC Medical Center, Roski Eye Institute, Los Angeles, California, U.S.A
| | - Steven C Dresner
- Eyesthetica, Los Angeles, California, U.S.A
- Department of Ophthalmology, Los Angeles County, USC Medical Center, Roski Eye Institute, Los Angeles, California, U.S.A
| | - David B Samimi
- Eyesthetica, Los Angeles, California, U.S.A
- Department of Ophthalmology, Los Angeles County, USC Medical Center, Roski Eye Institute, Los Angeles, California, U.S.A
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Barone N, Lalonde DH, Brutus JP. Tips, Tricks, and Pearls for a Superior Patient and Surgeon Experience for Wide-awake Dupuytren Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5570. [PMID: 38313593 PMCID: PMC10836878 DOI: 10.1097/gox.0000000000005570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
Fasciectomy for Dupuytren disease is a common procedure traditionally performed with a tourniquet under general or regional anesthesia. Since the year 2001, the wide-awake local anesthesia no tourniquet (WALANT) approach has been applied successfully to Dupuytren surgery, with current excellent surgeon and patient satisfaction. However, using WALANT for Dupuytren surgery may be intimidating for hand surgeons who want to begin using this method. The purpose of this article is to offer a series of tips and tricks the authors have learned after having performed hundreds of WALANT fasciectomies, to make this technique easier for surgeons and a more pleasurable experience for patients.
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Affiliation(s)
| | - Donald H Lalonde
- Division of Plastic Surgery, Dalhousie University, Saint John, New Brunswick, Canada
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Mun HG, Moon BM, Kim YJ. Comparison of pain relief in soft tissue tumor excision: anesthetic injection using an automatic digital injector versus conventional injection. Arch Craniofac Surg 2024; 25:17-21. [PMID: 38461824 PMCID: PMC10924788 DOI: 10.7181/acfs.2023.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The pain caused by local anesthetic injection can lead to patient anxiety prior to surgery, potentially necessitating sedation or general anesthesia during the excision procedure. In this study, we aim to compare the pain relief efficacy and safety of using a digital automatic anesthetic injector for local anesthesia. METHODS Thirty-three patients undergoing excision of a benign soft tissue tumor under local anesthesia were prospectively enrolled from September 2021 to February 2022. A single-blind, randomized controlled study was conducted. Patients were divided into two groups by randomization: the experimental group with digital automatic anesthetic injector method (I-JECT group) and the control group with conventional injection method. Before surgery, the Amsterdam preoperative anxiety information scale was used to measure the patients' anxiety. After local anesthetic was administered, the Numeric Pain Rating Scale was used to measure the pain. The amount of anesthetic used was divided by the surface area of the lesion was recorded. RESULTS Seventeen were assigned to the conventional group and 16 to the I-JECT group. The mean Numeric Pain Rating Scale was 1.75 in the I-JECT group and 3.82 in conventional group. The injection pain was lower in the I-JECT group (p< 0.01). The mean Amsterdam preoperative anxiety information scale was 11.00 in the I-JECT group and 9.65 in conventional group. Patient's anxiety did not correlate to injection pain regardless of the method of injection (p= 0.47). The amount of local anesthetic used per 1 cm 2 of tumor surface area was 0.74 mL/cm2 in the I-JECT group and 2.31 mL/cm2 in the conventional group. The normalization amount of local anesthetic was less in the I-JECT group (p< 0.01). There was no difference in the incidence of complications. CONCLUSION The use of a digital automatic anesthetic injector has shown to reduce pain and the amount of local anesthetics without complication.
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Affiliation(s)
- Hye Gwang Mun
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Bo Min Moon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Yu Jin Kim
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Park HS, Choi JW. A novel nerve block technique for nail surgery. Pediatr Dermatol 2024; 41:177-179. [PMID: 37987239 DOI: 10.1111/pde.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
In pediatric patients, nail unit anesthesia is frequently required for procedures including matrixectomy or nail avulsion. However, nail unit anesthesia is very painful and requires a significant amount of time to take complete effect, causing a great deal of distress for most pediatric patients. By targeting the palmar and dorsal digital nerves in the distal part of the fingers, our method enables fast, simple, and less painful anesthesia.
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Affiliation(s)
- Hyoung Soo Park
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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Mayich DJ. Wide-Awake Local Anesthetic No Tourniquet Surgery of the Foot and Ankle. Orthop Clin North Am 2023; 54:471-483. [PMID: 37718086 DOI: 10.1016/j.ocl.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Wide awake local anesthetic no tourniquet (WALANT) surgery of the foot and ankle has the potential to offer safe and effective surgeon-based anesthesia for a significant number of surgeries about the foot and ankle. This has been documented with significant and growing body of literature. WALANT could offer significant advantages with respect to patient experience, per case cost of procedures as well as for improving access for patients to operative resources in a setting of scarcity or restricted access.
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Affiliation(s)
- D Joshua Mayich
- Stanton Territorial Hospital, 548 Byrne Road, Yellowknife, NT, Canada.
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McLennan L, Haines M, Graham D, Sullivan T, Lawson R, Sivakumar B. Regional Anesthesia in Upper-Limb Surgery. Ann Plast Surg 2023; 91:187-193. [PMID: 37450877 DOI: 10.1097/sap.0000000000003592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Local and regional anesthesia is associated with numerous clinical and institutional advantages relative to general anesthesia. As anesthesiologists and surgeons increasingly integrate local and regional anesthesia into their clinical practice, an understanding of the principles, evolution, and trends underpinning modern anesthetic techniques continues to be relevant. METHODS A review of the literature in databases Medline, PubMed, and EMBASE identified recent developments, ongoing trends, and historical milestones in upper-limb regional anesthesia. RESULTS Advances in regional anesthetic techniques in the last century have led to reduced postoperative pain, improved safety, and improved outcomes in upper-limb surgery. The development of ultrasound-guided techniques, as well as pharmacological advances in local anesthetic drugs and adjuncts, has further advanced the role of regional anesthesia. Wide-awake local anesthesia with no tourniquet has allowed certain procedures to be performed on select patients in outpatient and low-resource settings. CONCLUSIONS This review provides an overview of local and regional anesthesia in the upper-limb from its historical origins to its contemporary applications in upper-limb surgery, particularly during the COVID-19 pandemic.
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Affiliation(s)
| | - Morgan Haines
- Plastic and Reconstructive Surgery, Royal North Shore Hospital, Sydney
| | - David Graham
- Gold Coast University Hospital, Gold Coast, Australia
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Admani A, Sherman I, Jani P, Mwamuye A, Sepehripour S, Lalonde D. Below-knee Amputation with Minimally Painful Injection of Tumescent Local Anesthesia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5164. [PMID: 37496983 PMCID: PMC10368383 DOI: 10.1097/gox.0000000000005164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/20/2023] [Indexed: 07/28/2023]
Abstract
We successfully performed minimally painful injection of tumescent local anesthesia to eliminate the need for the tourniquet and sedation for a below-knee amputation in a frail patient with multiple medical comorbidities in Mombasa, Kenya. Minimal pain injection of WALANT (wide awake local anesthesia no tourniquet) pure local anesthesia can be a good alternative for lower limb amputation in frail patients when safe sedation services are unavailable or unaffordable in many countries.
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Affiliation(s)
- Asif Admani
- From the Coast General Teaching and Referral Hospital, Department of Surgery, Mombasa, Kenya
| | - Imraan Sherman
- From the Coast General Teaching and Referral Hospital, Department of Surgery, Mombasa, Kenya
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | - Arnold Mwamuye
- From the Coast General Teaching and Referral Hospital, Department of Surgery, Mombasa, Kenya
| | - Sarvnaz Sepehripour
- Birmingham Women’s and Children’s National Health Service Foundation Trust, Birmingham, England
| | - Donald Lalonde
- Division of Plastic Surgery, Dalhousie University, Saint John, New Brunswick, Canada
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Lalonde DH, Sepehripour S. Tips to Successful Flexor Tendon Repair and Reconstruction with WALANT. Hand Clin 2023; 39:165-170. [PMID: 37080648 DOI: 10.1016/j.hcl.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
WALANT has generated many changes that have improved flexor tendon repair and reconstruction in the last 10 years. Seeing awake unsedated educable patients move repaired reconstructed tendons during the surgery has changed how we do surgery and therapy in many ways for the better. This article offers many tips on how to get better results in using these new techniques with the help of WALANT.
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Affiliation(s)
- Donald H Lalonde
- Dalhousie University, Suite C204, 600 Main Street, Saint John, NB E2K 1J5, Canada.
| | - Sarvnaz Sepehripour
- Birmingham Women's and Children's National Health Service Foundation Trust, Steelhouse Lane, Birmingham, England B4 6NH, UK
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Brutus JP, Lalonde DH. How to Create an Exceptional Hand Surgery Patient Experience with WALANT. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4681. [PMID: 37720889 PMCID: PMC10503683 DOI: 10.1097/gox.0000000000004681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/29/2022] [Indexed: 03/08/2023]
Abstract
This article provides practical tips that surgeons can use to improve their patient experience with wide awake local anesthesia no tourniquet hand surgery. The difference between patient satisfaction and patient experience is explained. Delivering a superior patient experience leads to better outcomes for patients, less postoperative complications, and a better quality of life and practice for the surgeon. Practical tips are presented, broken down into the preoperative, operative, and postoperative phases. Surgeons who commit to improving their patient experience will enjoy superior outcomes, patient loyalty, more fulfillment, and a rejuvenated sense of purpose.
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Affiliation(s)
- Jean Paul Brutus
- From Exception MD, Montreal, Quebec, Canada
- Dalhousie University, Saint John, New Brunswick, Canada
| | - Donald H. Lalonde
- From Exception MD, Montreal, Quebec, Canada
- Division of Plastic Surgery, Dalhousie University, Saint John, New Brunswick, Canada
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Jarragh A, Lari A, Burhamah W, Alherz M, Nouri A, Alshammari Y, Al-Jasim A, AlRefai S, Alnusif N. Comparison of pain and extent of anesthesia in digital blocks for isolated finger lacerations: A randomized controlled trial. Turk J Emerg Med 2022; 22:125-130. [PMID: 35936956 PMCID: PMC9355069 DOI: 10.4103/tjem.tjem_344_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES: Digital injuries are among the most common presentations to the emergency department. In order to sufficiently examine and manage these injuries, adequate, prompt, and predictable anesthesia is essential. In this trial, we aim to primarily compare the degree of pain and anesthesia onset time between the two-injection dorsal block technique (TD) and the single-injection volar subcutaneous block (SV) technique. Further, we describe the temporal and anatomical effects of both techniques for an accurate delineation of the anesthetized regions. METHODS: This is a single-center prospective randomized controlled trial involving patients presenting with isolated wounds to the fingers requiring primary repair under local anesthesia. Patients were randomized to either the SV or TD blocks. The primary outcome was procedure-related pain (Numerical Rating Scale). Further, we assessed the extent of anesthesia along with the anesthesia onset time. RESULTS: A total of 100 patients were included in the final analysis, 50 on each arm of the study. The median pain score during injection was significantly higher in patients who received TD block than patients who received SV block (median [interquartile range] = 4 [2.25, 5.00] vs. 3.00 [2.00, 4.00], respectively, P = 0.006). However, anesthesia onset time was not statistically different among the groups (P = 0.39). The extent of anesthesia was more predictable in the dorsal block compared to the volar block. CONCLUSION: The single-injection volar subcutaneous blocks are less painful with a similar anesthesia onset time. Injuries presenting in the proximal dorsal region may benefit from the two-injection dorsal blocks, given the anatomical differences and timely anesthesia of the region.
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Affiliation(s)
- Ali Jarragh
- Department of Surgery, Kuwait University, Al-Shuwaikh, Kuwait
| | - Ali Lari
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Waleed Burhamah
- Department of Plastic Surgery, AlBabtain Hospital, Al-Shuwaikh, Kuwait
| | - Mohammed Alherz
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Abdullah Nouri
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Yahia Alshammari
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Ameer Al-Jasim
- Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Sulaiman AlRefai
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Naser Alnusif
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
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Lalonde DH. Ten Questions About Wide Awake Local Anaesthesia No Tourniquet (WALANT) Surgery. J Hand Surg Asian Pac Vol 2022; 27:219-225. [PMID: 35443890 DOI: 10.1142/s2424835522300031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this review article is to provide many important tips and tricks for surgeons to start Wide Awake Local Anaesthesia No Tourniquet (WALANT) hand surgery in their practice. The massive cost reduction of this disruptive new approach will enable them to increase access to hand surgery for their patients who cannot afford unnecessary sedation or unnecessary sterility of the expensive main operating room environment. Evidence-based sterility will permit surgeons to move a lot of their surgery out of the main operating room to minor procedure rooms without a significant increase in infection rates. Important pointers on how to inject minimally painful local anaesthesia will have patients thinking the surgeon injector is a bit of a magician. WALANT enables surgeons to improve the outcomes of many hand surgery procedures. Level of Evidence: Level V (Therapeutic).
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