The Use of Wide-Awake Local Anesthesia No Tourniquet (WALANT) Technique for Distal Fibula Hardware Removal

Abstract

Ankle fracture is one of the most common fractures that are mainly treated with open reduction and internal fixation. Wide-awake local anesthesia no tourniquet (WALANT) technique has been widely used for hand and wrist surgeries, this method has been scarcely utilized in ankle surgery. To the best of our knowledge, only one study has evaluated the safety and efficacy of the WALANT technique in distal fibula hardware removal surgeries. This study aimed to investigate the result of using the WALANT technique in distal fibula hardware removal surgery. From April 2020 until March 2021 randomized clinical trial was performed on 60 patients between the ages of 18 and 60 years in our educational orthopedic center. In group A, an anesthesiologist administered spinal anesthesia and in group B the WALANT technique was used for anesthesia. The results of the current study showed that the visual analog scale in group B a day after the surgery was significantly lower, in comparison to group A. The outcome of our study demonstrated lesser blood loss in patients operated under the WALANT. This finding could be related to the vasoconstrictive properties of epinephrine used in the WALANT solution. Our findings suggest that the WALANT technique application in the proper setting and appropriate patient selection could lead to reduced postoperative pain, minimal bleeding, and shorter admission time. Other advantages include the simplicity and safety of the technique, it is being time and cost-effective.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.