Less Fluctuation in Hemodynamics of the Wide-Awake Local Anesthesia No Tourniquet Technique Than General Anesthesia in Distal Radius Plating Surgery: A Prospective Case-Control Study

Abstract

This prospective case-control study aimed to compare the intraoperative hemodynamic changes between the wide-awake local anesthesia no tourniquet (WALANT) technique and general anesthesia (GA) in patients undergoing distal radius plating surgery. Forty adults with distal radius fractures underwent plating surgery via the WALANT technique (20 patients) or GA (20 patients). Mean arterial pressure (MAP) and heart rate were recorded. Intraoperative pain intensity was measured using the visual analog scale (VAS) for pain in the WALANT group. The measures of hemodynamics and VAS were recorded at seven-time points perioperatively. The VAS score decreased significantly compared with the preoperative status in the WALANT group for most of the intraoperative period except during injections of local anesthetics and fracture reduction. The intraoperative MAP in the WALANT group showed no significant change during the perioperative period. In addition, the WALANT group showed fewer perioperative MAP fluctuations than the GA group (p < 0.05). The reduction and plating quality were similar between the two groups. WALANT provided a feasible technique with less fluctuation in hemodynamic status. With gentle manipulation of the fracture reduction, distal radius plating surgery using the WALANT technique is a well-tolerated surgical procedure and shows similar reduction and plating quality to GA.

Keywords: WALANT; balanced anesthesia; distal radius fracture; wide-awake hand surgery; wide-awake local anesthesia no tourniquet.

Figure 1

Graphs showing the perioperative changes in mean arterial pressure (MAP) and heart rate (HR). (A) Preoperative MAP (T0) exhibited no statistically significant differences between the wide-awake local anesthesia no tourniquet (WALANT) group and the general anesthesia (GA) group. MAP in the GA group dropped after the induction of anesthesia. The WALANT group showed less fluctuation in MAP than the GA group. (B) The preoperative HR showed no statistically significant differences between the two groups. HR exhibited a mild increase in the WALANT group and a greater decrease in the GA group. The WALANT group showed less fluctuation in HR than the GA group. The error bars represent standard error of the mean.