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Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis.
J Hand Surg Asian Pac Vol. 2019 Dec; 24(4):469-476.JH

Abstract

Background:

To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet.

Methods:

We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies.

Results:

The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative times by 2.06 minutes (pooled mean difference, random effects, 95% confidence interval 0.46 to 3.67 minutes, p = 0.01, I2 0%, p = 0.66). The post-operative pain scores were lower in the WALANT group by an average of two VAS points (random effects, pooled mean difference -2.40, 95% confidence interval -3.41 to -1.38, p < 0.00001; I2 0% p = 0.99). We had insufficient evidence to demonstrate a difference in terms of patient satisfaction (random effects, pooled risk ratio 0.98, 95% confidence interval 0.93 to 1.03, p = 0.36, I2 0%, p = 0.64) and complication rates (random effects, pooled risk ratio 0.40, 95% confidence interval 0.07 to 2.18, p = 0.29, I2 60% p = 0.08) between WALANT versus conventional methods.

Conclusions:

The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates.

Authors+Show Affiliations

Department of Orthopedic Surgery, University of Santo Tomas Hospital, Manila, Philippines.Department of Orthopedic Surgery, University of Santo Tomas Hospital, Manila, Philippines.Levana Dermatology Clinic, Quezon City, Metro Manila, Philippines.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31690188

Citation

Evangelista, Ted Matthew P., et al. "Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Local or Intravenous Regional Anesthesia With Tourniquet in Atraumatic Hand Cases in Orthopedics: a Systematic Review and Meta-Analysis." The Journal of Hand Surgery Asian-Pacific Volume, vol. 24, no. 4, 2019, pp. 469-476.
Evangelista TMP, Pua JHC, Evangelista-Huber MTP. Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis. J Hand Surg Asian Pac Vol. 2019;24(4):469-476.
Evangelista, T. M. P., Pua, J. H. C., & Evangelista-Huber, M. T. P. (2019). Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis. The Journal of Hand Surgery Asian-Pacific Volume, 24(4), 469-476. https://doi.org/10.1142/S2424835519500619
Evangelista TMP, Pua JHC, Evangelista-Huber MTP. Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Local or Intravenous Regional Anesthesia With Tourniquet in Atraumatic Hand Cases in Orthopedics: a Systematic Review and Meta-Analysis. J Hand Surg Asian Pac Vol. 2019;24(4):469-476. PubMed PMID: 31690188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis. AU - Evangelista,Ted Matthew P, AU - Pua,John Hubert C, AU - Evangelista-Huber,Mara Therese P, PY - 2019/11/7/entrez PY - 2019/11/7/pubmed PY - 2020/2/11/medline KW - Epinephrine KW - Hand surgery KW - Tourniquet KW - WALANT KW - Wide awake SP - 469 EP - 476 JF - The journal of hand surgery Asian-Pacific volume JO - J Hand Surg Asian Pac Vol VL - 24 IS - 4 N2 - Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies. Results: The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative times by 2.06 minutes (pooled mean difference, random effects, 95% confidence interval 0.46 to 3.67 minutes, p = 0.01, I2 0%, p = 0.66). The post-operative pain scores were lower in the WALANT group by an average of two VAS points (random effects, pooled mean difference -2.40, 95% confidence interval -3.41 to -1.38, p < 0.00001; I2 0% p = 0.99). We had insufficient evidence to demonstrate a difference in terms of patient satisfaction (random effects, pooled risk ratio 0.98, 95% confidence interval 0.93 to 1.03, p = 0.36, I2 0%, p = 0.64) and complication rates (random effects, pooled risk ratio 0.40, 95% confidence interval 0.07 to 2.18, p = 0.29, I2 60% p = 0.08) between WALANT versus conventional methods. Conclusions: The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates. SN - 2424-8363 UR - https://www.unboundmedicine.com/medline/citation/31690188/Wide_Awake_Local_Anesthesia_No_Tourniquet__WALANT__versus_Local_or_Intravenous_Regional_Anesthesia_with_Tourniquet_in_Atraumatic_Hand_Cases_in_Orthopedics:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://www.worldscientific.com/doi/full/10.1142/S2424835519500619?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -