Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 5;17(1):100153.
doi: 10.1016/j.jham.2024.100153. eCollection 2025 Jan.

Comparison of WALANT and general anaesthesia for trapeziectomy and abductor pollicis longus hammock ligamentoplasty

Kürşat Reşat Demi R  1 , Feray Karademi R  2 , Egemen Ayhan  3 , Can Emre Baş  4 , Önder Ersan  5
Affiliations

Comparison of WALANT and general anaesthesia for trapeziectomy and abductor pollicis longus hammock ligamentoplasty

Kürşat Reşat Demi R et al. J Hand Microsurg. .

Abstract

Background: Trapeziectomy and abductor pollicis longus hammock ligamentoplasty may be performed in the surgical management of trapeziometacarpal joint osteoarthritis (TMC OA). Several anaesthesia techniques are available for TMC joint surgery, including wide-awake local anaesthesia no tourniquet (WALANT), regional anaesthesia, and general anaesthesia (GA). The aim of this study was to compare the clinical outcomes of trapeziectomy and abductor pollicis longus hammock ligamentoplasty performed under WALANT versus GA.

Methods: This retrospective study included 22 patients who underwent surgery for TMC OA between 2017 and 2019. Patients' pre- and post-operative pain intensity, grip and pinch strength, and functional scores were compared. Pain intensity was assessed 1 h after surgery, while overall outcome measures were evaluated one year post-operatively.

Results: The results showed that patients who underwent WALANT had significantly lower pain intensity 1 h postoperatively compared to those who received GA. Both groups experienced a reduction in pain, improvement in grip strength, and functional scores after at one year, with no significant differences between them. No significant differences were found between the GA and WALANT groups in terms of postoperative VAS scores, grip strength, and functional scores.

Conclusions: We recommend WALANT for trapeziectomy and APL hammock ligamentoplasty due to its effectiveness in reducing early post-operative pain and achieving functional outcomes comparable to those of GA.

Keywords: Carpometacarpal joint; Hammock ligamentoplasty; Trapeziectomy; Trapeziometacarpal osteoarthritis; WALANT.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: FERAY KARADEMIR reports equipment, drugs, or supplies was provided by Hacettepe University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A. Surgical incision. Radial artery in suspension. B. Trapezium excision. C. FCR at the base of the excised trapezium. D. Two bands of tenotomised APL encircling the FCR.
Fig. 2
Fig. 2
A. Superficial tissue injection. B. Surgical site inflated with WALANT solution. C. Deep tissue injection. D. Surgical site where WALANT has been applied.
See this image and copyright information in PMC

References

    1. Eaton R.G., Littler J.W. Ligament reconstruction for the painful thumb carpometacarpal joint. J. Bone Jt. Surg. 1973;55(8):1655–1666. - PubMed
    1. Vermeulen G.M., Slijper H., Feitz R., Hovius S.E., Moojen T.M., Selles R.W. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg. 2011;36(1):157–169. doi: 10.1016/j.jhsa.2010.10.028. - DOI - PubMed
    1. Elfar J.C., Burton R.I. Ligament reconstruction and tendon interposition for thumb basal arthritis. Hand Clin. 2013;29(1):15–25. doi: 10.1016/j.hcl.2012.08.018. - DOI - PMC - PubMed
    1. Mckee Daniel MD., Lalonde Donald MD. Wide awake trapeziectomy for thumb basal joint arthritis. Plast. Reconstr. Surg., Glob. Open. 2017;5(8):e1435. doi: 10.1097/gox.0000000000001435. - DOI - PMC - PubMed
    1. Moscato L., Laborde A., Kouyoumdjian P., Coulomb R., Mares O. Trapeziometacarpal (TMC) arthroplasty under Wide Awake Local Anesthesia with No Tourniquet (WALANT) versus Local Anesthesia with peripheral nerve blocks (LAPNV): perioperative pain and early functional results in 30 patients. Hand Surg Rehabıl. 2021;40(4):453–457. - PubMed

LinkOut - more resources