Wide-Awake Local Anesthesia, No Tourniquet Surgery in the Philippines

Abstract

The use of wide-awake local anesthesia, no tourniquet (WALANT) has been adapted by most hand surgeons in the Philippines. This is especially true for centers with a large volume of patients needing specialized care for the hand. The use of WALANT has enabled surgeons to do procedures on an outpatient basis, thus potentially creating cost-saving measures for patients and health care facilities. Aside from common outpatient procedures like carpal tunnel syndrome, trigger finger, and de Quervain tenosynovitis, open reduction internal fixation of hand fractures, acute tendon repairs, tendon transfers, and reconstructions have been performed under WALANT as outpatient procedures. The future of WALANT surgery in the Philippines is promising. Teaching WALANT to other areas of the country can counterbalance the large disproportion of hand surgeons to patients and the concentration of specialized care in urban areas. This will enable patients to receive surgical hand care without going to large urban centers.

Keywords: Local anesthesia; WALANT; Wide-awake surgery.

Figure 1

A Patient 1 intraoperative view of repaired flexor digitorum profundus and 1 slip of FDS on active extension on the right little finger. B Active flexion in patient 1 with good tension. C Patient 1 at 6 months follow-up shows good little finger flexion (right little finger). D Patient 1 at 6 months follow-up with slight proximal interphalangeal joint contracture of the little finger on extension.

Figure 2

Patient 2 with an extensor lag of the ring finger right hand.

Figure 3

A Patient 3 with a shaft fracture of the little finger. B Patient 3 with scissoring of the little finger. C Patient 3 at 3 months follow-up with good fracture healing. D Patient 3 with good finger motion and no scissoring.

Figure 4

A Patient 5 tumescent anesthesia for tendon transfer of EIP to EPL of the right. B Patient 5 intraoperative view of EIP harvest and transfer. C Patient 5 at 3 months follow-up for the “thumbs up” sign of the right compared with the left. D Patient 5 at 3 months follow-up with good wrist extension.

Figure 5

Patient 6 with magnetic resonance image of “perched” ECU on forearm pronation and supination.