WALANT: Perceptions, approaches, and contraindications in a tertiary hand surgery unit

Wide awake local anesthetic no tourniquet (WALANT) is gaining popularity amongst hand surgeons. Digital adrenaline use has been shown to be safe in multiple studies and the misconception forbidding it is receding. Phentolamine has been shown to safely reverse the effects of adrenaline should the fea...

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Bibliographic Details
Published in:Hand surgery and rehabilitation 2022-06, Vol.41 (3), p.311-316
Main Authors: McCaughran, P.W., Zargaran, D., Southall, C., Kokkinos, C., Caine, P., Nikkhah, D., Mosahebi, A.
Format: Article
Language:English
Subjects:
Adrenaline
Adrénaline
Chirurgie de la main
Hand surgery
Phentolamine
Risks
Risques
Safety
Sécurité
WALANT
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Summary:Wide awake local anesthetic no tourniquet (WALANT) is gaining popularity amongst hand surgeons. Digital adrenaline use has been shown to be safe in multiple studies and the misconception forbidding it is receding. Phentolamine has been shown to safely reverse the effects of adrenaline should the feared complication of digital ischemia occur. A survey was circulated to 40 specialist practitioners who regularly perform hand procedures at a major tertiary plastic and hand surgery unit. Knowledge and understanding of WALANT, onset and duration of adrenaline effects and reversal was assessed. Whilst the majority of respondents (80%) recognized digital adrenaline use as safe, only 65% were aware of the delay until adrenaline takes full effect. Similarly, only 25% of respondents were aware of the duration of effect of adrenaline. Half of respondents were aware that phentolamine is the established reversal agent for adrenaline with only 20% knowing the correct dose. Given the lack of clinician knowledge surrounding adrenaline and its reversal, we feel that to safely undertake WALANT surgery at our Unit a WALANT protocol must be implemented. Drawing on the successes in the airline industry, a variety of safety frameworks have been established to deliver targeted education for prevention and eventual management of predictable risks. We plan to develop a checklist style protocol targeting the knowledge gaps raised in the survey. This will educate and equip all practitioners working with adrenaline with the knowledge to safely manage complications should they occur. Level 5 (UK Oxford Centre for Evidence based Medicine (CEBM) Levels of Evidence). La popularité de l’anesthésie de type WALANT (“Wide awake local anesthetic no tourniquet”) grandit chez les chirurgiens de la main. L’utilisation de l’adrénaline au doigt s’est révélée être sans danger dans de multiples études et l’idée fausse à l’origine de son interdiction tend à disparaitre. Il a été démontré que la Phentolamine inhibe les effets de l'adrénaline sans risque dans les cas où une complications de type ischémie digitale surviendrait. Un questionnaire a été envoyé à 40 spécialistes qui pratiquent régulièrement des opérations de la main dans une unité tertiaire de chirurgie de la main. Il s’agissait d’ évaluer la connaissance et la compréhension de la WALANT, les délais de l’anesthésie, du garrot chimique et les risques de complications liés de l’adrénaline. Si la majorité des personnes ayant répondu (80%) ont r
ISSN:2468-1229
2468-1210
DOI:10.1016/j.hansur.2022.01.002