Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults

Abstract

Background: A considerable percentage of ER admissions are related to hand flexor tendons injuries. Operation on flexor tendon required perfect bloodless surgical field which can be achieved through using tourniquet. Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique can be used for hand surgeries where hemostasis provided by injecting adrenaline locally.We compared the use of WALANT versus supraclavicular brachial plexus block for flexor tendons repair regarding the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction Methods: 52 patients were enrolled for hand flexor tendon repair were randomly divided into one of two groups (26 in each) WALANT or SC-BPB with a tourniquet. Results: Intraoperative pain assessment during injection (p = 0.04) was higher in SC-BPB, while tourniquet-related pain was reported in 23% of patients of SC-BPB group (p =0.001).Induction time was shorter in WALANT (p <0.01) while, time needed to obtain sufficient hemostasis was longer in WALANT than SC-BPB (p <0.01) with comparable surgical time (p = 0.538). higher blood loss was found in WALANT (p <0.01). Patients expressed higher level of satisfaction with WALANT technique (P value 0.032) & their wish to have same type of anesthesia if to undergo similar procedure in the futureConclusion: WALANT technique is a good alternative to SC-BPB in flexor tendon repair surgeries being technically simple, low cost & efficient technique. BPB still an acceptable technique specially when considerable blood loss is expected.