The rise of wide awake hand surgery - Contribution from Turkey

Abstract

Objectives: Recently, many surgeons started to prefer wide awake local anesthesia no tourniquet (WALANT) approachto provide an almost bloodless field for the vast majority of hand surgery procedures. We aimed to present our two-yearexperience with WALANT technique.Methods: A wide variety of 682 hand surgery operations in 626 patients were performed with WALANT technique. Forinfiltrative local anesthesia, the mixture of 1% lidocaine, 1:100.000 epinephrine and 8.4% bicarbonate was prepared. Theneed for intraoperative sedation and intraoperative patient cooperation were evaluated. Patients' fingers were observed incase of postoperative circulatory compromise. A simple cost-effectivity analysis for the anesthesia types was performed.Results: Mean age of the patients was 43.7. None of the patients needed intraoperative sedation, and patients obeyed toorders of surgeon throughout the procedure. The postoperative circulatory compromise was observed in two fingers; onefinger resolved spontaneously and the other rescued with phentolamine. WALANT technique was more cost-effective thanBier block or general anesthesia.Conclusion: The WALANT technique seems like a great innovation to perform a wide variety of hand surgery cases. Increased patient comfort without a tourniquet, cost-effectivity, no preoperative tests, no risks of general anesthesia, no needto stay in the hospital overnight, and intraoperative active motion assessment facility are important advantages.