WORLD JOURNAL OF PLASTIC SURGERY
Thu, Nov 21, 2024
[Archive]
Volume 13, Issue 2 (2024)
WJPS 2024, 13(2): 3-10 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Alnojaidi T, Alaqil S, Alqahtani R, Albraithen G, Almutairi R, Khubrani A et al . Intraoperative Hemostasis Using WALANT Versus Tourniquet; A Focused Review on Carpal Tunnel Syndrome and Trigger Finger Release. WJPS 2024; 13 (2) :3-10
URL: http://wjps.ir/article-1-1279-en.html
URL: http://wjps.ir/article-1-1279-en.html
Taif Alnojaidi * 
1, Sultan Alaqil2 , Reemah Alqahtani3 , Ghaida Albraithen4 , Rahaf Almutairi5 , Abdullah Khubrani6 , Abdulmajeed Alhadlaq7
1, Sultan Alaqil2 , Reemah Alqahtani3 , Ghaida Albraithen4 , Rahaf Almutairi5 , Abdullah Khubrani6 , Abdulmajeed Alhadlaq7
1- 1. Department of Plastic and Reconstructive Surgery, King Fahad Medical City, Riyadh, Saudi Arabia , Taiffawaz11@gmail.com
2- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
3- King Khaled University, Abha, Saudi Arabia
4- King Saud University Medical City, Riyadh, Saudi Arabia
5- Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
6- Department of Plastic Surgery, Prince Sultan Military Medical City the Department of Scholarship Ministry of Health, Riyadh, Saudi Arabia
7- Department of Surgery, Imam Mohammad Ibn Saud University Riyadh, Saudi Arabia
2- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
3- King Khaled University, Abha, Saudi Arabia
4- King Saud University Medical City, Riyadh, Saudi Arabia
5- Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
6- Department of Plastic Surgery, Prince Sultan Military Medical City the Department of Scholarship Ministry of Health, Riyadh, Saudi Arabia
7- Department of Surgery, Imam Mohammad Ibn Saud University Riyadh, Saudi Arabia
Abstract: (1679 Views)
Maintaining intraoperative haemostasis is crucial when conducting wide-awake hand surgeries, this is particularly to improve visibility which will improve patient’s outcome. There are various methods that could achieve the aforementioned, some of which is wide awake local anaesthesia without tourniquet (WALANT) or Tourniquet alongside sedation. Each method has its own benefits and drawbacks. This study primarily focuses on Carpal Tunnel Syndrome and Trigger Finger release. A comprehensive literature review was conducted through PUBMED, Scopus, google scholar, and web of science. A total of 45 articles were included in the study. We aimed to assess whether the literature supports the use of a tourniquet alongside sedation, or only local anesthesia and epinephrine in wide awake hand surgeries. Moreover, we aimed to highlight the benefits and drawbacks of using a tourniquet, and determine the patient population most likely to benefit from tourniquet application.
References
1. Ki Lee S, Gul Kim S, Sik Choy W. A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet. Orthop Traumatol Surg Res 2020;106(8):1645-1651. doi:10.1016/j.otsr.2020.03.013 [DOI:10.1016/j.otsr.2020.03.013]
2. Saleh E, Saleh J, Govshievich A, Ferland-Caron G, Lin JC, Tremblay DM. Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial. Plast Reconstr Surg Glob Open 2021;9(4):e3513. Published 2021 Apr 8. doi:10.1097/GOX.0000000000003513 [DOI:10.1097/GOX.0000000000003513]
3. Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Surg 2013;21(8):443-447. doi:10.5435/JAAOS-21-08-443 [DOI:10.5435/JAAOS-21-08-443]
4. Lalonde DH, Wong A. Dosage of local anesthesia in wide awake hand surgery. J Hand Surg Am 2013;38(10):2025-2028. doi:10.1016/j.jhsa.2013.07.017 [DOI:10.1016/j.jhsa.2013.07.017]
5. Lalonde D. Minimally invasive anesthesia in wide awake hand surgery. Hand Clin 2014;30(1):1-6. doi:10.1016/j.hcl.2013.08.015 [DOI:10.1016/j.hcl.2013.08.015]
6. Tang JB, Xing SG, Ayhan E, Hediger S, Huang S. Impact of Wide-Awake Local Anesthesia No Tourniquet on Departmental Settings, Cost, Patient and Surgeon Satisfaction, and Beyond. Hand Clin 2019;35(1):29-34. doi:10.1016/j.hcl.2018.08.012 [DOI:10.1016/j.hcl.2018.08.012]
7. Lalonde DH. Latest Advances in Wide Awake Hand Surgery. Hand Clin 2019;35(1):1-6. doi:10.1016/j.hcl.2018.08.002 [DOI:10.1016/j.hcl.2018.08.002]
8. Gunasagaran J, Sean ES, Shivdas S, Amir S, Ahmad TS. Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet. J Orthop Surg (Hong Kong) 2017;25(3):2309499017739499. doi:10.1177/2309499017739499 [DOI:10.1177/2309499017739499]
9. Tang JB. Local Anesthesia Without Tourniquet in Hand and Forearm Surgery: My Story of Using and Promoting it. Hand Clin 2019;35(1):xv-xx. doi:10.1016/j.hcl.2018.10.002 [DOI:10.1016/j.hcl.2018.10.002]
10. Bhattacharya S. Sushrutha - our proud heritage. Indian J Plast Surg 2009;42(2):223-5. [DOI:10.1055/s-0039-1699348]
11. Noordin S, McEwen JA, Kragh JF Jr, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. J Bone Joint Surg Am [Internet] 2009 [cited 2023 Apr 17];91(12):2958-67. Available from: https://pubmed.ncbi.nlm.nih.gov/19952261/ [DOI:10.2106/JBJS.I.00634]
12. Cushing H. Pneumatic tourniquets: with especial reference to their use in craniotomies. Medical news; 1904. p. 577.
13. Akinyoola AL, Oginni LM, Orimolade EA, Ogundele OJ. Esmarch tourniquet in orthopaedic surgery. Trop Doct [Internet] 2007 [cited 2023 Apr 17];37(3):139-41. Available from: https://pubmed.ncbi.nlm.nih.gov/17716495/ [DOI:10.1258/004947507781524827]
14. Whitehead DJ, MacDonald SJ. TKA sans tourniquet: let it bleed: opposes. Orthopedics 2011 [cited 2023 Apr 17];34(9):e497-9. Available from: https://pubmed.ncbi.nlm.nih.gov/21902143/ [DOI:10.3928/01477447-20110714-44]
15. Hutchinson DT, McClinton MA. Upper extremity tourniquet tolerance. J Hand Surg Am [Internet] 1993 [cited 2023 Apr 17];18(2):206-10. Available from: https://pubmed.ncbi.nlm.nih.gov/8463580/ [DOI:10.1016/0363-5023(93)90347-6]
16. Odinsson A, Finsen V. The position of the tourniquet on the upper limb. J Bone Joint Surg Br [Internet] 2002 [cited 2023 Apr 17];84(2):202-4. Available from: https://pubmed.ncbi.nlm.nih.gov/11922360/ [DOI:10.1302/0301-620X.84B2.12777]
17. Estebe JP, Mallédant Y. Pneumatic tourniquets in orthopedics. Ann Fr Anesth Reanim 1996 [cited 2023 Apr 17];15(2):162-78. Available from: https://pubmed.ncbi.nlm.nih.gov/8734236/ [DOI:10.1016/0750-7658(96)85038-6]
18. Olaiya OR, Alagabi AM, Mbuagbaw L, McRae MH. Carpal tunnel release without a tourniquet: A systematic review and meta-analysis. Plast Reconstr Surg 2020 [cited 2023 Apr 17];145(3):737-44. Available from: https://pubmed.ncbi.nlm.nih.gov/32097317/ [DOI:10.1097/PRS.0000000000006549]
19. Odinsson A, Finsen V. Tourniquet use and its complications in Norway. J Bone Joint Surg Br 2006 [cited 2023 Apr 17];88(8):1090-2. Available from: https://pubmed.ncbi.nlm.nih.gov/16877612/ [DOI:10.1302/0301-620X.88B8.17668]
20. Kam PC, Kavanagh R, Yoong FF. The arterial tourniquet: pathophysiological consequences and anaesthetic implications: The arterial tourniquet. Anaesthesia 2001 [cited 2023 Apr 17];56(6):534-45. Available from: https://pubmed.ncbi.nlm.nih.gov/11412159/ [DOI:10.1046/j.1365-2044.2001.01982.x]
21. Maury AC, Roy WS. A prospective, randomized, controlled trial of forearm versus upper arm tourniquet tolerance. J Hand Surg Br 2002 [cited 2023 Apr 17];27(4):359-60. Available from: https://pubmed.ncbi.nlm.nih.gov/12162977/ [DOI:10.1054/jhsb.2002.0787]
22. Malanjum LS, Fischer B. Procedures under tourniquet. Anaesth Intensive Care Med 2006;7(3):81-3. Available from: https://www.sciencedirect.com/science/article/pii/S1472029906002086 [DOI:10.1383/anes.2006.7.3.81]
23. Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake Local Anesthesia with No Tourniquet: An Updated Review. Plast Reconstr Surg Glob Open 2021 Mar 10;9(3):e3507. doi: 10.1097/GOX.0000000000003507. PMID: 33786267; PMCID: PMC7997095. [DOI:10.1097/GOX.0000000000003507]
24. Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol. 2017 Oct;42(8):886-895. doi: 10.1177/1753193417728427. PMID: 28886668. [DOI:10.1177/1753193417728427]
25. Segal KR, Debasitis A, Koehler SM. Optimization of Carpal Tunnel Syndrome Using WALANT Method. J Clin Med 2022 Jul 3;11(13):3854. doi: 10.3390/jcm11133854. PMID: 35807138; PMCID: PMC9267271. [DOI:10.3390/jcm11133854]
26. Fish MJ, Bamberger HB. Wide-awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery. PMID: 34033408
27. Kim KH, Cho JG, Lee KO, Seo TJ, Shon CY, Lim SY, et al. Usefulness of physical maneuvers for prevention of vasovagal syncope. Circ J 2005 [cited 2023 Sep 18];69(9):1084-8. Available from: https://pubmed.ncbi.nlm.nih.gov/16127191/ [DOI:10.1253/circj.69.1084]
28. Thakkar M, Bednarz B. WALANT and sickle cell disease: A cautionary tale. J Plast Reconstr Aesthet Surg 2021 [cited 2023 Sep 19];74(7):1633-701. Available from: https://pubmed.ncbi.nlm.nih.gov/33726989/ [DOI:10.1016/j.bjps.2021.02.001]
29. Connors KM, Kurtzman JS, Koehler SM. Successful use of WALANT in local and regional soft tissue flaps: A case series. Plast Reconstr Surg Glob Open 2023 [cited 2023 Sep 19];11(1):e4756. Available from: http://dx.doi.org/10.1097/gox.0000000000004756 [DOI:10.1097/GOX.0000000000004756]
30. Bina B, Hersh EV, Hilario M, Alvarez K, McLaughlin B. True allergy to amide local anesthetics: A review and case presentation. Anesth Prog 2018 [cited 2023 Sep 19];65(2):119-23. Available from: https://pubmed.ncbi.nlm.nih.gov/29952645/ [DOI:10.2344/anpr-65-03-06]
31. Tahir M, Chaudhry EA, Zaffar Z, Anwar K, Mamoon MAH, Ahmad M, et al. Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: A randomized control trial of a cost-effective and resource-friendly procedure. Bone Joint Res 2020 [cited 2023 Sep 19];9(7):429-39. Available from: http://dx.doi.org/10.1302/2046-3758.97.bjr-2019-0315.r1 [DOI:10.1302/2046-3758.97.BJR-2019-0315.R1]
32. Turcotte JJ, Gelfand JM, Jones CM, Jackson RS. Development of a Low-Resource Operating Room and a Wide-Awake orthopedic surgery program during the COVID-19 pandemic. Surg Innov 2021 [cited 2023 Sep 19];28(2):183-8. Available from: https://pubmed.ncbi.nlm.nih.gov/33780646/ [DOI:10.1177/15533506211003530]
33. Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada. Hand (N Y) 2007 [cited 2023 Sep 18];2(4):173-8. Available from: https://pubmed.ncbi.nlm.nih.gov/18780048/ [DOI:10.1007/s11552-007-9043-5]
34. Kazmers NH, Presson AP, Xu Y, Howenstein A, Tyser AR. Cost implications of varying the surgical technique, surgical setting, and anesthesia type for carpal tunnel release surgery. J Hand Surg Am 2018 [cited 2023 Sep 18];43(11):971-977.e1. Available from: https://pubmed.ncbi.nlm.nih.gov/29784549/ [DOI:10.1016/j.jhsa.2018.03.051]
35. Alter TH, Warrender WJ, Liss FE, Ilyas AM. A cost analysis of carpal tunnel release surgery performed Wide Awake versus under sedation. Plast Reconstr Surg 2018 [cited 2023 Sep 18];142(6):1532-8. Available from: https://pubmed.ncbi.nlm.nih.gov/30188472/ [DOI:10.1097/PRS.0000000000004983]
36. LeBlanc MR, Lalonde DH, Thoma A, Bell M, Wells N, Allen M, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y) 2011 [cited 2023 Sep 18];6(1):60-3. Available from: https://pubmed.ncbi.nlm.nih.gov/22379440/ [DOI:10.1007/s11552-010-9301-9]
37. Avoricani A, Dar QA, Levy KH, Koehler SM. WALANT hand surgery: Do the AORN guidelines apply? J Surg Orthop Adv 2021 [cited 2023 Sep 18];30(3). Available from: https://pubmed.ncbi.nlm.nih.gov/34591004/ [DOI:10.3113/JSOA.2021.0156]
38. Kardestuncer M, Kardestuncer T. Office-based open trigger finger release has a low complication rate. J Hand Surg Glob Online 2022;4(3):153-5. Available from: http://dx.doi.org/10.1016/j.jhsg.2022.01.008 [DOI:10.1016/j.jhsg.2022.01.008]
39. Sasor SE, Cook JA, Duquette SP, Lucich EA, Cohen AC, Wooden WA, et al. Tourniquet use in Wide-Awake carpal tunnel release. Hand (N Y) 2020 [cited 2023 Sep 18];15(1):59-63. Available from: https://pubmed.ncbi.nlm.nih.gov/30003819/ [DOI:10.1177/1558944718787853]
40. Far-Riera AM, Pérez-Uribarri C, Sánchez Jiménez M, Esteras Serrano MJ, Rapariz González JM, Ruiz Hernández IM. Estudio prospectivo sobre la aplicación de un circuito WALANT para la cirugía del síndrome del túnel carpiano y dedo en resorte. Rev Esp Cir Ortop Traumatol 2019 [cited 2023 Sep 18];63(6):400-7. Available from: https://pubmed.ncbi.nlm.nih.gov/31471242/ [DOI:10.1016/j.recot.2019.06.006]
41. Dar Q-A, Avoricani A, Rompala A, Levy KH, Shah NV, Choueka D, et al. WALANT hand surgery does not require postoperative opioid pain management. Plast Reconstr Surg 2021 [cited 2023 Sep 19];148(1):121-30. Available from: https://pubmed.ncbi.nlm.nih.gov/34181608/ [DOI:10.1097/PRS.0000000000008053]
42. Huang YC, Hsu CJ, Renn JH, Lin KC, Yang SW, Tarng YW, Chang WN, Chen CY. WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet. J Orthop Surg Res 2018 Aug 06;13(1):195. [DOI:10.1186/s13018-018-0903-1]
43. Rhee PC, Fischer MM, Rhee LS, McMillan H, Johnson AE. Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures. J Hand Surg Am 2017 Mar;42(3):e139-e147. [DOI:10.1016/j.jhsa.2016.11.019]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
