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Abstract
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Introduction :
Wide Awake Local Anaesthesia No Tourniquet (WALANT) is a commonly used operating technique in hand surgery. Adrenaline mixed with the locally injected anaesthetics limits bleeding during the procedure, but does not completely eliminate it, as a tourniquet would do with endovenous anaesthesia (EVA).
The aim of this study is to evaluate the operating time for carpal tunnel and spring finger releases of assistant physicians in training for the title of specialist in orthopaedic surgery and traumatology, under the supervision of a hand surgeon. Our hypothesis being that the operating times are slightly longer with a WALANT anaesthesia technique compared to an endovenous anaesthesia (EVA) technique but that the rate of early complications is similar.
Method :
This is a retrospective study comparing patients operated on by assistant physicians, in training for the title of specialist in orthopaedic and trauma surgery, with isolated carpal tunnel release or isolated spring finger release under endovenous anaesthesia, performed by an anaesthesiologist, and under WALANT, performed by the surgical team. Operations involving other simultaneous procedures were excluded. The operating time was measured from incision to closure. Patients were followed up at 2, 6 and 12 weeks post-operatively and the following complications were investigated: wound dehiscence, infection, neurological lesion and incomplete neurolysis (persistence of symptoms).
Results :
Between January 2017 and January 2021, 34 carpal tunnel releases (18 under EVA and 16 under WALANT) and 44 spring finger releases (24 under AEV and 20 under WALANT) were completed. The mean operating time for carpal tunnel release was 14.6 and 20.1 minutes, under EVA and WALANT, respectively (p-value < 0.05). The mean operative time for spring finger release was 16.0 and 15.8 minutes under EVA and WALANT, respectively (p-value 0.49). There were no complications in either group.
Conclusions and perspectives :
The WALANT makes it possible to continue to teach assistant physicians in training for the title of specialist in orthopaedic surgery and traumatology, in hand surgery. Compared to endovenous anaesthesia, the operating time is increased by about 25% for carpal tunnel release but unchanged for spring finger, while not increasing the complication rate.
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