Wide Awake Local Anestesia No Tourniguet (WALANT) Tekniği ile Yapılan Ortopedik Üst Ekstremite Cerrahilerinin Klinik ve Fonksiyonel Sonuçları

Öz

Amaç: Wide Awake Local Anesthesia No Tourniqet (WALANT) yöntemi lokal anestezi altında turnikesiz olarak ekstremite cerrahilerinde kullanılan bir tekniktir. Bu araştırmanın amacı, üst ekstremite cerra-hilerinde WALANT tekniğinin etkinliğini ve kemik ve yumuşak doku cerrahilerinin karşılaştırmasınıkar-şılaştırmasını incelemektir. Materyal ve metod: Mayıs 2021 ile Nisan 2023 arasında, WALANT tekniği kullanılarak üst ekstremite cerrahisi geçiren 39 hasta çalışmaya dahil edildi. Hastalar iki gruba ayrıldı: grup A yumuşak doku ameli-yatları ve grup B kemik doku ameliyatları. Gruplar arasında postoperatif ağrı başlangıç zamanı, ağrı skoru, intraoperatif kanama, ek solüsyon gereksinimi, koter kullanımı ve cerrahi alanındaki kanama miktarı açısından karşılaştırma yapıldı. Cerrahi işlem sırasında ağrı seviyelerini değerlendirmek için Görsel Analog Skala (VAS) kullanıldı. Bulgular: İki grup arasında yaş, cinsiyet ve operasyon yapılan taraf açısından belirgin farklılık bulunma-dı. Her iki grup hastalarında, cerrahın değerlendirmesine göre ameliyat sırasında benzer bir kanama miktarı izlendi. Ek solüsyon ihtiyacı, koter kullanımı, ağrı başlangıç zamanı ve VAS skorları açısından gruplar arasında farklılık gözlenmedi. Sonuç: WALANT tekniği, uygun şekilde seçilmiş hastalarda üst ekstremite kemik ve yumuşak doku operasyonlarında kullanılabilen etkili ve güvenli bir yöntemdir. Genel veya geniş bölgesel anestezi yerine lokal anestezi altında turnike olmaksızın kanamasız bir ameliyat cerrah ve hasta konforu açısın-dan etkilidir. Tekniğin uygun bir şekilde uygulanması, olası komplikasyonları önlemek açısından önemlidir.

Anahtar Kelimeler

• uyanık turnikesiz lokal anestezi
• lokal anestezi
• üst ekstremite

Orthopedic Upper Extremity Surgeries Performed with Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique: Clinical and Functional Outcomes

Öz

Background: The Wide Awake Local Anesthesia No Tourniquet (WALANT) method is a technique used in extremity surgeries under local anesthesia without the use of a tourniquet. The aim of this study is to examine the effectiveness of the WALANT technique in upper extremity surgeries and compare it with outcomes related to bone and soft tissue. Materials and Methods: Between May 2021 and April 2023, 39 patients who underwent upper extremity surgery using the WALANT technique were included in the study. The patients were divi-ded into two groups: Group A for soft tissue surgeries and Group B for bone tissue surgeries. A compa-rison was made between the groups regarding postoperative pain onset time, pain scores, intraopera-tive bleeding, additional solution requirements, cautery usage, and the amount of bleeding in the surgical field. The Visual Analog Scale (VAS) was used to assess pain levels during the surgical procedu-re. Results: There were no significant differences between the two groups in terms of age, gender, and the side of the operation. According to the surgeon's assessment, both groups exhibited similar amo-unts of bleeding during the surgery. Additionally, there were no differences between the two groups regarding the need for additional solutions, the use of cautery, the onset of pain, and VAS scores. Conclusions: The WALANT technique is an effective and safe method that can be used for bone and soft tissue surgeries of the upper extremity in appropriately selected patients. Performing surgery under local anesthesia without a tourniquet is beneficial for both the surgeon and the patient, as it results in a bloodless operation. Proper application of the technique is crucial to prevent potential complications.

Anahtar Kelimeler

• wide-awake local anesthesia with no tourniquet
• local anesthesia
• upper extremity

Kaynakça

1. 1. O'Neill N, Abdall-Razak A, Norton E, et al. Use of Wide-Awake Local Anaesthetic No Tourniquet (WALANT) in upper limb and hand surgery: A systematic review protocol. Int J Surg Protoc. 2020;20:8-12.
2. 2. Pinsornsak P, Pinitchanon P, Boontanapibul K. Effect of Diffe-rent Tourniquet Pressure on Postoperative Pain and Complica-tions After Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial. J Arthroplasty. 2021;36(5):1638-44.
3. 3. Kukreja P, Lehtonen E, Pinto MC, Patel HA, McKissack HM, Shah A. Postoperative Tourniquet Pain in Patients Undergoing Foot and Ankle Surgery. Cureus. 2018;10(12):e3678.
4. 4. Connors KM, Guerra SM, Koehler SM. Current Evidence Invol-ving WALANT Surgery. J Hand Surg Glob Online. 2022;4(6):452-455.
5. 5. Arık HO, Baz AB, Yüncü M, Yapar A, Köse Ö. Comparison of inf-raclavicular brachial plexus block versus wide-awake local anesthesia no-tourniquet technique in the management of ra-dial shortening osteotomy. Jt Dis Relat Surg. 2022;33(1):109-16.
6. 6. Pamuk Ç. Metatarsal osteotomy for hallux valgus under wide-awake local anesthesia with no tourniquet technique. Jt Dis Re-lat Surg. 2022;33(2):367-73.
7. 7. Degreef I, Lalonde DH. WALANT surgery of the hand: state of the art. EFORT Open Rev. 2024;9(5):349-356.
8. 8. Ruxasagulwong S, Kraisarin J, Sananpanich K. Wide awake tech-nique versus local anesthesia with tourniquet application for minor orthopedic hand surgery: a prospective clinical trial. J Med Assoc Thai. 2015;98(1):106-10.

9. 9. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhou-sie Project clinical phase. J Hand Surg Am. 2005;30(5):1061-7.
10. 10. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108(1):114-24.
11. 11. Huang YC, Hsu CJ, Renn JH, Lin KC, Yang SW, Tarng YW, et al. WALANT for distal radius fracture: Open reduction with plating fixation via wide-awake local anesthesia with no tourniquet. J Orthop Surg Res 2018;13:195.
12. 12. Tan E, Bamberger HB, Saucedo J. Incorporating office-based surgery into your practice with WALANT. J Hand Surg Am 2020;45:977-81.
13. 13. Rafiqi K, Kamil S, Benzmane K. Wide-awake local anesthesia for osteotomy of distal radius malunion. Hand Surg Rehabil 2020;39:339-40.
14. 14. Abdullah S, Tokiran MF, Ahmad AA, Soh EZF, Makpol S, Sapuan J. Safety of Lidocaine During Wide-Awake Local Anesthesia No To-urniquet for Distal Radius Plating. J Hand Surg Glob Online. 2023;5(2):196-200.
15. 15. Kuzucu Y, Ayhan E, Tuna Z, Ersan Ö. Zone 1-2 Flexor Tendon Repair Results With WALANT. Hand and Microsurgery 2021;10(3):219
16. 16. Ayhan E, Akaslan F. Patients' Perspective on Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia. Plast Reconstr Surg. 2020;145(5):1197-203.
17. 17. Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake Local Anest-hesia with No Tourniquet: An Updated Review. Plast Reconstr Surg Glob Open. 2021;9(3):e3507.
18. 18. Abitbol A, Merlini L, Masmejean EH, Gregory T. Applying the WALANT technique to surgical treatment of distal radius fractu-res. Hand Surg Rehabil. 2021;40(3):277-82.
19. 19. Ahmad AA, Sabari SS, Ruslan SR, Abdullah S, Ahmad AR. Wide-Awake Anesthesia for Olecranon Fracture Fixation. Hand (NY). 2021;16(3):402-6.
20. 20. Bilgetekin YG, Kuzucu Y, Öztürk A, Yüksel S, Atilla HA, Ersan Ö. The use of the wide-awake local anesthesia no tourniquet technique in foot and ankle injuries. Foot Ankle Surg. 2021;27(5):535-8.
21. 21. Li YS, Chen CY, Lin KC, Tarng YW, Hsu CJ, Chang WN. Open reduction and internal fixation of ankle fracture using wide-awake local anaesthesia no tourniquet technique. Injury. 2019;50(4):990-4.
22. 22. Çetin BV, Kaptan AY, Orhan Ö, Altay MA, Altay N, Demir S, De-mir M. Comparison of the effectiveness of the WALANT method in soft tissue and bone tissue surgeries in lower extremities. Jt Dis Relat Surg. 2023 May 12;34(2):439-444.