Impact of WALANT Hand Surgery in a Secondary Care Hospital in Spain. Benefits to the Patient and the Health System.

Purpose: The aim of this study is to compare patient benefits and economic costs of hand surgeries using the wide-awake local anesthesia no tourniquet (WALANT) technique versus a conventional major outpatient suite and review outcomes and complications in a series of cases of patients operated on using the WALANT technique. Methods: A prospective cohort study was first conducted comparing 150 cases of ambulatory hand surgery (carpal tunnel syndrome and trigger finger) using the WALANT technique and not requiring an operating room setting with 150 cases of outpatient surgery performed in an operating room involving a preoperative evaluation and the use of sedation and tourniquet. Preoperative, intraoperative, and postoperative pain was monitored, and days requiring postoperative analgesia were recorded. The resources and costs were evaluated. and patient satisfaction was assessed using a specific survey.Subsequently, 580 patient medical records were retrospectively reviewed, including 419 carpal tunnel syndrome and 197 trigger finger interventions (616 WALANT surgeries). Results: Intraoperative pain was equivalent for both groups, and postoperative pain was significantly lower in the WALANT group, with a reduced need for analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital materials was reduced in the WALANT group, with a total estimated cost savings of 1.019 USD per patient.There were no complications related to the WALANT technique and the lidocaine and adrenaline combination. We found a complication rate of 5.58%, and, in line with the literature, most complications were minor, managed conservatively, and not related to the anesthetic technique. Conclusions: Procedures such as carpal tunnel and trigger finger surgeries can be safely performed using wide-awake surgery. Patient satisfaction is higher than with the conventional procedure performed in the operating room. Pain control is excellent, especially during the postoperative period. Clinical relevance: Hand surgery patients benefit from the WALANT technique in terms of comfort and timeliness because there is no need for preoperative tests or evaluations. In addition, it represents significant savings in hospital resources. In our case series, complications were in line with those previously reported with other anesthetic techniques.

Estudio prospectivo sobre la aplicación de un circuito WALANT para la cirugía del síndrome del túnel carpiano y dedo en resorte / Prospective study on the application of a WALANT circuit for surgery of tunnel carpal syndrome and trigger finger

Objetivo: Evaluar los beneficios para el paciente y el impacto económico de la implantación de un circuito de cirugía con anestesia local sin manguito ni sedación (wide awake local anesthesia no tourniquet technique [WALANT], por sus siglas en inglés) comparado con pacientes intervenidos en quirófano con cirugía mayor ambulatoria. Método: Se diseñó un estudio de cohortes prospectivo comparando 150 casos intervenidos (túneles carpianos y dedo en resorte) de forma ambulatoria mediante técnica WALANT con otros 150 pacientes operados en circuito de cirugía mayor ambulatoria, con evaluación preoperatoria, anestesia regional y torniquete, en quirófano convencional. El dolor pre-, intra- y postoperatorio fue monitorizado, así como los días que precisaron de analgesia postoperatoria. Se evaluaron los costos y recursos utilizados. El grado de satisfacción del paciente fue evaluado mediante un formulario específico. Resultados: El dolor intraoperatorio fue similar en ambos grupos, hallando diferencias significativas en cuanto a la necesidad de analgesia postoperatoria a favor del grupo WALANT. El grado de satisfacción fue mayor para el grupo de anestesia local. La utilización de recursos materiales y de personal fue menor en WALANT, calculando un ahorro por paciente de 1,019 euros. Conclusiones: Cirugías como el túnel carpiano y el dedo en resorte pueden llevarse a cabo de forma segura mediante la técnica WALANT. La satisfacción del paciente es mayor que la de los pacientes intervenidos en el quirófano. El control del dolor es excelente, especialmente durante el postoperatorio. La técnica WALANT reporta un beneficio para el paciente en términos de bienestar y rapidez, además de permitir prescindir de pruebas y visita preoperatorias. Su implantación supone un ahorro significativo de recursos hospitalarios

Objectives: To evaluate benefits for the patient and the economic impact for the implementation of a wide awake local anesthesia no tourniquet (WALANT) hand surgery compared to traditional major outpatient circuit. Methods: A prospective cohort study was planned comparing 150 cases of ambulatory hand surgery (carpal tunnel and trigger finger) using WALANT technique intervention out from the operating room; with another 150 which underwent intervention, outpatient setting, with preoperative evaluation, sedation and tourniquet, in the operation room. Preoperative, intraoperative and postoperative pain was monitored, as well as the days that required postoperative analgesia.The resources used and costs were evaluated. Satisfaction was evaluated using a specific survey. Results: The pain during the surgery was equivalent for both groups and was significantly lower postoperatively for the WALANT group, with less need for the use of analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital material was less for the WALANT group, with total saving calculated by 1,019 euros per patient. Conclusions: Procedures such as carpal tunnel surgery and trigger finger surgery can be safely performed using wide awake surgery. Patient satisfaction is higher to conventional procedure in the operation room. Pain control is excellent, especially during the postoperative period. WALANT technique for hand surgery represents a benefit for the patient in comfort, timeliness and no need for preoperative tests or evaluation. In addition, it represents a significant savings in hospital resources

Prospective study on the application of a WALANT circuit for surgery of tunnel carpal syndrome and trigger finger. / Estudio prospectivo sobre la aplicación de un circuito WALANT para la cirugía del síndrome del túnel carpiano y dedo en resorte.

OBJECTIVES: To evaluate benefits for the patient and the economic impact for the implementation of a wide awake local anesthesia no tourniquet (WALANT) hand surgery compared to traditional major outpatient circuit. METHODS: A prospective cohort study was planned comparing 150 cases of ambulatory hand surgery (carpal tunnel and trigger finger) using WALANT technique intervention out from the operating room; with another 150 which underwent intervention, outpatient setting, with preoperative evaluation, sedation and tourniquet, in the operation room. Preoperative, intraoperative and postoperative pain was monitored, as well as the days that required postoperative analgesia.The resources used and costs were evaluated. Satisfaction was evaluated using a specific survey. RESULTS: The pain during the surgery was equivalent for both groups and was significantly lower postoperatively for the WALANT group, with less need for the use of analgesics. Satisfaction was greater for the local anesthesia group. The use of personnel resources and hospital material was less for the WALANT group, with total saving calculated by 1,019€ per patient. CONCLUSIONS: Procedures such as carpal tunnel surgery and trigger finger surgery can be safely performed using wide awake surgery. Patient satisfaction is higher to conventional procedure in the operation room. Pain control is excellent, especially during the postoperative period. WALANT technique for hand surgery represents a benefit for the patient in comfort, timeliness and no need for preoperative tests or evaluation. In addition, it represents a significant savings in hospital resources.