Wide-awake local anesthesia with no tourniquet as effective as balanced anaesthesia for DRF plating surgery

Distal radius fracture (DRF) is a common injury that can require surgical intervention. The use of wide-awake local anesthesia with no tourniquet (WALANT) has been investigated in several studies for DRFs. Despite WALANT being suitable for all cases of DRF surgeries is still being determined for its detrimental effects.

Chih-Ting Chen and team in the study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and balanced anesthesia (BA). The study found that with preoperative planning WALANT technique could be an alternative for DRF plating surgery in selected patients. They found there was reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and BA groups. The study findings are published in Journal of Orthopaedic Surgery and Research.

A total of 93 patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received BA, comprised of multimodal pain control brachial plexus anesthesia with light general support. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0–10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals and mean ± standard deviation.

The key findings of the study are

• The mean age of patients in the WALANT group was higher than in the BA group (63 ± 17 vs. 54 ± 17, P = 0.005), and there were fewer intra-articular DRF fractures in the WALANT group than in the BA group (AO type A/B/C: 30/3/5 vs. 26/10/19, P = 0.009).

• The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; − 8.0% [ − 15.7 to − 0.2%]).

• 6-month pronation (92% vs. 100%; − 9.1% [ − 17.0 to − 1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0–22.1%]).

• The overall satisfaction was comparable in the WALANT and BA groups (8.7 vs. 8.5; 0.2 [ − 0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7 ± 2.0, an intraoperative pain scale of 1.2 ± 1.9, and an intraoperative anxiety scale of 2.3 ± 2.8.

Research concluded that “The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and BA groups. With meticulous preoperative planning, the WALANT technique could be an alternative for DRF plating surgery in selected patients.”

Reference: Chen, CT., Chou, SH., Huang, HT. et al. Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study. J Orthop Surg Res 18, 746 (2023). https://doi.org/10.1186/s13018-023-04243-0.