Est-ce que la WALANT est indispensable dans la « petite chirurgie » de la main ambulatoire ?

• Published in: Hand surgery and rehabilitation 2024-12, Vol.43 (6)
• Main Authors: Pietramala, Silvia, Fulchignoni, Camillo, Rocchi, Lorenzo
• Format: Article
• Language: fre
• ISSN: 2468-1229
• DOI: 10.1016/j.hansur.2024.101859

Wide Awake Local Anesthesia (WALANT) is an alternative to general or regional anesthesia that became popular among hand surgeons for being ideal for tendon repair in which the cooperation of the patients is crucial, avoiding the use of the tourniquet, also giving more comfort to the patients. On the other hand, the learning curve is long for the surgeon and the injection must take place at least 30minutes before starting the procedure, increasing the time needed to perform each surgery. Among the complications related to WALANT are digital ischemia and epinephrine-related-cardiac ischemia. Considering people undergoing CTR are mostly elderly and admitted to an outpatient service without the presence of an anesthesiologist, we cannot properly estimate the risk of adverse events. From February 2023 to November 2023, we selected 300 patients who underwent outpatients hand surgery (carpal tunnel release and trigger finger). Each patient was administered local anesthesia with lidocaine and a tourniquet at the arm was applied for the whole length of the surgery. Demographic data were collected as long as the time of the surgery, the type of the surgery and the pain and discomfort felt by the patients during the tourniquet on period (evaluated with VAS). Average length of the surgery was 12minutes. The most common surgery performed was carpal tunnel release. The mean value, according to VAS, was of 3.2. Furthermore, we noted that the VAS was higher in older patients and longer surgeries. In only 3 cases, the tourniquet had to be released before end of surgery because of patient discomfort. Despite WALANT being helpful and crucial to perform some hand surgeries, such as post-traumatic tenolysis or tendon repairs, the risk-benefit ratio doesn’t justify its use in short outpatient hand surgery. A limitation of our study is the lack of a control group to validate the effective disadvantage in terms of time and underestimated complications, considering the mean age of patients and the possible comorbidity that could interfere with the use of WALANT.