Wide Awake Local Anaesthesia No Tourniquet safe in upper limb orthopaedic procedures: study

Wide-Awake Local Anaesthesia No Tourniquet (WALANT), a groundbreaking anaesthetic technique resurging in practice, warrants a comprehensive safety analysis for informed adoption. Jad Lawand et al conducted a study to identify complications/side effects of WALANT upper limb procedures through a systematic review and meta-analysis.

A PROSPERO-registered study was performed with strict adherence to PRISMA guidelines. Embase, OVIDMedline, Cochrane, Web of Science, and Scopus databases were searched until February 2023. Inclusion criteria involved English articles, reporting complications/side effects in primary WALANT upper limb surgeries.

Two authors performed an independent and blind title and abstract screening. For the full-text review phase, two authors screened the eligible articles independently and blindly, and any discrepancy was discussed with the senior author to reach a consensus.

Outcomes included all complications and side effects, data on the anaesthetic mixture, publication year/location, study type, and procedures performed. The meta-analysis employed the Freeman-Tukey Double Arcsine Transformation, computed I2 statistics, and utilized common or random effects models for pooled analysis.

Key findings of the study were:

• 2002 studies were identified; 79 studies met the inclusion criteria representing 15,595 WALANT patients.

• A total of 301 patients had complications, and the meta-analysis using a random effects model provided a complication rate of 1.7% (95% CI: 0.93–2.7%).

• The most reported complications were superficial infection (41%, n=123/300), other/specified (12%, n=37/300), and recurrent disease (6.7%, n=20/300).

• A decade-by-decade analysis revealed no statistically significant difference in complication rates spanning the last three decades (p=0.42).

• In a subgroup analysis that classified included studies by mean age of participants into three age groups:65 years, encompassing 20, 30, and 7 studies, respectively, no statistically significant differences in complication rates were noted (p=0.58).

• Adding sodium bicarbonate to the anaesthetic solution significantly reduced postoperative complications (p=0.025).

The authors concluded that – “WALANT has a low overall complication rate of 1.7%, with no significant temporal variation and a significant reduction in complications when sodium bicarbonate is added to the anaesthetic solution. Our findings support the safety of WALANT in upper limb procedures.”

Further reading:

Complications and side effects of Wide Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta analysis

Jad Lawand, Ashraf Hantouly et al

International Orthopaedics

https://doi.org/10.1007/s00264-024-06104-9