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Bone Bulletin

Abstract

Introduction

The surgical technique known as wideawake local anesthesia no tourniquet (WALANT) has been widely used in soft tissue hand procedures since 2005.1 A local surgical field block using lidocaine with epinephrine provides local anesthesia and hemostasis via alpha-1 adrenergic agonism without the need for general anesthesia with a tourniquet. In addition to reducing costs related to general anesthesia (GA), WALANT procedures are suitable for American Society of Anesthesiologists Physical Status Classification 4 (ASA 4) high-risk patients, specifically by eliminating anesthesia risks such as nausea, aspiration, pneumonia, and thromboembolism, all while maintaining or improving clinical outcomes compared with the current standard of care.1 While WALANT has been documented for carpal tunnel release and trigger finger release since 2005, its use in bony procedures is more novel with its first documentation in the literature being between 2015 and 2017 in distal radial fracture plating (DRFP).2 While studies regarding the use of WALANT in other bony procedures are emerging, its use in DRFP remains the most studied out of all bony procedures. This article aims to investigate outcome variables, complication rates, and cost differences between using WALANT versus traditional anesthesia for DRFP, while also investigating the prospect of the technique extending into further bony procedures.

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