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. 2017 Jul 19;52(4):383-389.
doi: 10.1016/j.rboe.2017.05.006. eCollection 2017 Jun-Jul.

Is it safe to use local anesthesia with adrenaline in hand surgery? WALANT technique

Pedro José Pires Neto  1 , Leonardo de Andrade Moreira  1 , Priscilla Pires de Las Casas  1
Affiliations

Is it safe to use local anesthesia with adrenaline in hand surgery? WALANT technique

Pedro José Pires Neto et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

In the past it was taught that local anesthetic should not be used with adrenaline for procedures in the extremities. This dogma is transmitted from generation to generation. Its truth has not been questioned, nor the source of the doubt. In many situations the benefit of use was not understood, because it was often thought that it was not necessary to prolong the anesthetic effect, since the procedures were mostly of short duration. After the disclosure of studies of Canadian surgeons, came to understand that the benefits went beyond the time of anesthesia. The WALANT technique allows a surgical field without bleeding, possibility of information exchange with the patient during the procedure, reduction of waste material, reduction of costs, and improvement of safety. Thus, after passing through the initial phase of the doubts in the use of this technique, the authors verified its benefits and the patients' satisfaction in being able to immediately return home after the procedures.

Aprendemos que não deveríamos usar um anestésico local com adrenalina para procedimentos nas extremidades. Esse dogma é transmitido de geração em geração. Não questionávamos a sua veracidade ou a origem da dúvida. Em muitas situações não entendíamos o benefício do uso, pois muitas vezes pensávamos não ser necessário prolongar o efeito anestésico, já que os procedimentos eram, na sua maioria, de curta duração. Após a divulgação de estudos dos cirurgiões canadenses, passamos a entender que os benefícios se estendiam além do tempo de anestesia. A técnica Walant permite um campo cirúrgico sem sangramento, possibilidade de troca de informações com o paciente durante o procedimento, redução de material de descarte, redução de custos e melhoria da segurança. Dessa forma, após passar pela fase inicial das dúvidas quanto ao uso dessa técnica, verificamos os seus benefícios e a satisfação dos pacientes em poderem retornar de imediato para casa após os procedimentos.

Keywords: Adrenaline; Hand; Local anesthesia/administration and dosage; Local anesthesia/methods; Surgery.

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Figures

Fig. 1
Fig. 1
Injection technique. The needle penetrates perpendicular to the skin and below the dermis. The tilt will only be made after blocking (Courtesy Donald Lalond).
Fig. 2
Fig. 2
“Blow slow before you go” injection technique. The anesthetic is injected slowly before the needle is progressed. In this way, the nerve endings will be blocked by the anesthetic and the process will be painless (Courtesy Donald Lalond).
Fig. 3
Fig. 3
Blockade with lidocaine and adrenaline 30 min before the surgical procedure for carpal tunnel release.
Fig. 4
Fig. 4
(A) Blockade with lidocaine and adrenaline proximal and distal to the wrist fold; (B) beginning of the vasoconstriction effect after 15 min; (C) complete effect after 30 min.
Fig. 5
Fig. 5
(A) Carpal tunnel release approach under lidocaine/adrenaline effect; (B) after the procedure and still under lidocaine/adrenaline effect, maintaining a bloodless operating field.
See this image and copyright information in PMC

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