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. 2020 Jul 1;9(7):429-439.
doi: 10.1302/2046-3758.97.BJR-2019-0315.R1. eCollection 2020 Jul.

Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: A randomized control trial of a cost-effective and resource-friendly procedure

Muhammad Tahir  1 , Ejaz Ali Chaudhry  2 , Zain Zaffar  1 , Kashif Anwar  1 , Muhammad Ameer Hamza Mamoon  1 , Muhammad Ahmad  1 , Allah Rakhio Jamali  1 , Ghulam Mehboob  3
Affiliations

Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: A randomized control trial of a cost-effective and resource-friendly procedure

Muhammad Tahir et al. Bone Joint Res. .

Abstract

Aims: We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue.

Methods: This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier's block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant.

Results: Operations with WALANT proceeded sooner, and patients recovered faster, resulting in mean fewer missed working days (7.8 (SD 1.67)) compared with general anaesthesia (20.1 (SD 7.37)) or Bier's block (14.1 (SD 7.65)) (p < 0.001). The WALANT patients did not develop complications, while the other patients did (p < 0.04). Clinical outcomes did not differ, nor did surgeon qualification affect clinical outcomes. Mean hospital costs were lower for WALANT ($428.50 (SD 77.71)) than for general anaesthesia ($630.63 (SD 114.77)) or Bier's block ($734.00 (SD 37.54)) (p < 0.001). Patient satisfaction was also higher (p < 0.001).

Conclusion: WALANT for distal radius fractures results in a faster recovery, is more cost-effective, has similar clinical outcomes, and has fewer complications than general anaesthesia or Bier's block. This makes WALANT an attractive technique in any setting, but especially in middle- and low-income countries.Cite this article: Bone Joint Res 2020;9(7):429-439.

Keywords: Anaesthesia; Distal radius fracturex; Tourniquet; WALANT; Wide-awake.

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Figures

Fig. 1
Fig. 1
CONsolidated Standards Of Reporting Trials (CONSORT) flow diagram. WALANT, wide-awake local anaesthesia with no tourniquet.
Fig. 2
Fig. 2
Composition of wide-awake local anaesthesia with no tourniquet (WALANT) solution mixed in ratio of 1:1.
Fig. 3
Fig. 3
a) Haematoma block (2% lidocaine). b) Skin infiltration (subcutaneous plane) with wide-awake local anaesthesia with no tourniquet (WALANT) solution. c) Tumescent effect of WALANT solution. d) Periosteal block. e) Final implant position and surgical exposure.
Fig. 4
Fig. 4
Cross-sectional anatomy of the distal radius.
See this image and copyright information in PMC

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