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Wide Awake Local Anesthesia No Tourniquet: A Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center.
J Hand Surg Asian Pac Vol. 2019 Dec; 24(4):389-391.JH

Abstract

Background:

Wide Awake Local Anesthesia No Tourniquet (WALANT) uses a mixture of lidocaine and epinephrine for anesthesia and has found great success in hand surgery. At the Philippine Orthopedic Center (POC), we still use local anesthesia along with a tourniquet which gives the patient pain and discomfort at the tourniquet site. This study aims to determine perioperative and post-operative pain, intraoperative bleeding and immediate clinical outcomes of patients using WALANT for surgical anesthesia for carpal tunnel release.

Methods:

A case series of all patients who underwent carpal tunnel release under WALANT from April 2016 to September 2016 is presented. Those with concomitant trigger finger and de quervain disease which required release on the affected hand were also included. A tourniquet was on standby in case of uncontrollable bleeding. Intraoperative bleeding, pain NRS scores, and return to daily activity were noted.

Results:

Thirteen patients were included in the study; 3 were male, 10 were female. Mean age was 58 years, Mean surgical time was 15 minutes. Twelve were reported to have "some bleeding" and one was reported to have "bleeding but was still manageable". None of the surgeries were totally bloodless or had too much bleeding that necessitated a tourniquet. Pain NRS scores during injection of local anesthesia had a mean of 2. None of the patients felt pain during and immediately after the surgery. Average time return to daily activity was 6 days. No complications were noted.

Conclusions:

Patients included in the study who underwent carpal tunnel release under WALANT did not experience pain associated with a tourniquet. Visualization of the field was adequate enough for the surgeons to do the surgery without the need for a tourniquet and with no associated complications.

Authors+Show Affiliations

Philippine Orthopedic Center, Quezon, Philippines.Philippine Orthopedic Center, Quezon, Philippines.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31690194

Citation

Castro Magtoto, Ian Jason, and David Limlingan Alagar. "Wide Awake Local Anesthesia No Tourniquet: a Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center." The Journal of Hand Surgery Asian-Pacific Volume, vol. 24, no. 4, 2019, pp. 389-391.
Castro Magtoto IJ, Alagar DL. Wide Awake Local Anesthesia No Tourniquet: A Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center. J Hand Surg Asian Pac Vol. 2019;24(4):389-391.
Castro Magtoto, I. J., & Alagar, D. L. (2019). Wide Awake Local Anesthesia No Tourniquet: A Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center. The Journal of Hand Surgery Asian-Pacific Volume, 24(4), 389-391. https://doi.org/10.1142/S2424835519500486
Castro Magtoto IJ, Alagar DL. Wide Awake Local Anesthesia No Tourniquet: a Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center. J Hand Surg Asian Pac Vol. 2019;24(4):389-391. PubMed PMID: 31690194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Wide Awake Local Anesthesia No Tourniquet: A Pilot Study for Carpal Tunnel Release in the Philippine Orthopedic Center. AU - Castro Magtoto,Ian Jason, AU - Alagar,David Limlingan, PY - 2019/11/7/entrez PY - 2019/11/7/pubmed PY - 2020/2/11/medline KW - Anesthesia KW - Carpal Tunnel Syndrome KW - Epinephrine KW - Lidocaine SP - 389 EP - 391 JF - The journal of hand surgery Asian-Pacific volume JO - J Hand Surg Asian Pac Vol VL - 24 IS - 4 N2 - Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) uses a mixture of lidocaine and epinephrine for anesthesia and has found great success in hand surgery. At the Philippine Orthopedic Center (POC), we still use local anesthesia along with a tourniquet which gives the patient pain and discomfort at the tourniquet site. This study aims to determine perioperative and post-operative pain, intraoperative bleeding and immediate clinical outcomes of patients using WALANT for surgical anesthesia for carpal tunnel release. Methods: A case series of all patients who underwent carpal tunnel release under WALANT from April 2016 to September 2016 is presented. Those with concomitant trigger finger and de quervain disease which required release on the affected hand were also included. A tourniquet was on standby in case of uncontrollable bleeding. Intraoperative bleeding, pain NRS scores, and return to daily activity were noted. Results: Thirteen patients were included in the study; 3 were male, 10 were female. Mean age was 58 years, Mean surgical time was 15 minutes. Twelve were reported to have "some bleeding" and one was reported to have "bleeding but was still manageable". None of the surgeries were totally bloodless or had too much bleeding that necessitated a tourniquet. Pain NRS scores during injection of local anesthesia had a mean of 2. None of the patients felt pain during and immediately after the surgery. Average time return to daily activity was 6 days. No complications were noted. Conclusions: Patients included in the study who underwent carpal tunnel release under WALANT did not experience pain associated with a tourniquet. Visualization of the field was adequate enough for the surgeons to do the surgery without the need for a tourniquet and with no associated complications. SN - 2424-8363 UR - https://www.unboundmedicine.com/medline/citation/31690194/Wide_Awake_Local_Anesthesia_No_Tourniquet:_A_Pilot_Study_for_Carpal_Tunnel_Release_in_the_Philippine_Orthopedic_Center_ L2 - https://www.worldscientific.com/doi/full/10.1142/S2424835519500486?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -