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Review
. 2022 Jun 27:9:922135.
doi: 10.3389/fsurg.2022.922135. eCollection 2022.

Wide-Awake Local Anesthesia With no Tourniquet Versus General Anesthesia for the Plating of Distal Radius Fracture: A Systematic Review and Meta-Analysis

Ting-Yu Tu  1 , Chih-Yang Hsu  2 , Pei-Chin Lin  3   4 , Chun-Yu Chen  1   5   6
Affiliations
Review

Wide-Awake Local Anesthesia With no Tourniquet Versus General Anesthesia for the Plating of Distal Radius Fracture: A Systematic Review and Meta-Analysis

Ting-Yu Tu et al. Front Surg. .

Abstract

Background: Distal radius fractures are treated using open reduction and internal fixation and using general anesthesia (GA) or regional blocks. A new technique, wide-awake local anesthesia with no tourniquet (WALANT), allows this operation to be conducted in nonsedated patients without the use of tourniquets.

Objective: We analyzed whether WALANT yields better outcomes than GA in the treatment of patients with distal radius fractures.

Evidence review: We searched the PubMed, Cochrane Library, Embase, and Scopus databases for cases of distal radius fractures treated using WALANT or GA. The outcomes of interest were duration of preparation for surgery, duration of surgery, blood loss, and length of postoperative hospitalization; visual analog scale (VAS), Mayo wrist score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire score on postoperative day 1; range of motion (ROM); time until bone union; and complication rate.

Findings: We systematically reviewed 4 studies with a total of 263 patients (128 with WALANT and 135 with GA). In comparison with GA, WALANT required less time for preparation for surgery, shorter postoperative hospitalization, and lower postoperative day 1 VAS scores; however, blood loss was greater. Functional outcomes (ROM, QuickDASH score, and Mayo wrist score), complication rates, and times until union did not differ considerably between the two methods.

Conclusion: The included studies demonstrated that durations of preparation for surgery and postoperative hospitalization were shorter and pain on postoperative day 1 was less severe with WALANT than with GA. Although blood loss in surgery was greater with WALANT, this technique is a novel and promising alternative to GA.

Keywords: GA; WALANT; distal radius; fixation; fracture; general anesthesia; wide-awake local anesthesia no tourniquet.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection.
Figure 2
Figure 2
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Figure 2
Figure 2
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Figure 2
Figure 2
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Figure 2
Figure 2
(A) Forest plot of Preparation time for surgery (minute) comparing WALANT with GA. (B) Forest plot of Surgery time (minute) comparing WALANT with GA. (C) Forest plot of Blood loss (mL) comparing WALANT with GA. (D) Forest plot of Postoperative Hospital stays comparing WALANT with GA. (E) Forest plot of Post-operation day 1 visual analog scale (VAS) comparing WALANT with GA. (F) Forest plot of Mayo Wrist score comparing WALANT with GA. (G) Forest plot of Quick DASH score comparing WALANT with GA. (H) Forest plot of Wrist Flexion (degree) comparing WALANT with GA. (I) Forest plot of Wrist Extension (degree) comparing WALANT with GA. (J) Forest plot of Union time (week) comparing WALANT with GA. (K) Forest plot of Complication rate comparing WALANT with GA.
See this image and copyright information in PMC

References

    1. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. (2012) 28(2):113–25. 10.1016/j.hcl.2012.02.001 - DOI - PMC - PubMed
    1. Tahir M, Chaudhry EA, Zaffar Z, Anwar K, Mamoon MAH, Ahmad M, et al. Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique. Bone Joint Res. (2020) 9(7):429–39. 10.1302/2046-3758.97.BJR-2019-0315.R1 - DOI - PMC - PubMed
    1. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive scases of elective epinephrine use in the fingers and hand: the dalhousie project clinical phase. J Hand Surg. (2005) 30(5):1061–7. 10.1016/j.jhsa.2005.05.006 - DOI - PubMed
    1. Pires Neto PJ, Moreira LA, Las Casas PP. Is it safe to use local anesthesia with adrenaline in hand surgery? WALANT technique. Rev Bras Ortop. (2017) 52(4):383–9. 10.1016/j.rbo.2017.05.002 - DOI - PMC - PubMed
    1. Codding JL, Bhat SB, Ilyas AM. An economic analysis of MAC versus WALANT: a trigger finger release surgery case study. Hand (New York, NY). (2017) 12(4):348–51. 10.1177/1558944716669693 - DOI - PMC - PubMed

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