Our Summary

This research paper looks into a technique called WALANT (Wide Awake Local Anesthesia No Tourniquet) which is commonly used in hand surgery. The study surveyed a group of plastic surgery trainees in the UK about their knowledge of the standard WALANT formula, which mixes lidocaine and adrenaline. However, the researchers found that due to local regulations, the trainees were using a different mixture of adrenaline than the standard one.

The paper also compared the amounts of this WALANT mixture used by trainees during surgery, with published UK data. They found that on average, the trainees were using less of the mixture than what was reported in the UK data.

The researchers concluded that even though there is official guidance for the use of WALANT from the British Society for Surgery of the Hand, there is still a lot of variation in how it’s being used. They also suggested that most hand surgeries can be done with less WALANT than previously thought, while still maintaining safety and effectiveness.

FAQs

  1. What is the WALANT technique used in hand surgery?
  2. What did the research find about the variation in use of WALANT among plastic surgery trainees in the UK?
  3. Is it possible to perform hand surgeries with less WALANT while still maintaining safety and effectiveness?

Doctor’s Tip

A doctor might tell a patient undergoing hand surgery to ask about the specific technique and anesthesia being used, such as WALANT, to ensure they are informed about the procedure and potential risks. It is important for patients to be proactive in their healthcare and advocate for their own well-being.

Suitable For

Patients who are typically recommended hand surgery include those with conditions such as carpal tunnel syndrome, trigger finger, arthritis, tendon injuries, fractures, nerve damage, and congenital deformities. Hand surgery may also be recommended for patients who have suffered traumatic injuries to the hand or fingers. Additionally, hand surgery may be recommended for patients who have chronic pain or limited function in the hand that has not improved with conservative treatments.

Timeline

  • Before hand surgery:
  1. Patient consults with a hand surgeon to discuss the procedure and potential risks and benefits.
  2. Patient undergoes pre-operative testing and evaluation to ensure they are healthy enough for surgery.
  3. Patient receives information on how to prepare for surgery, including fasting guidelines and medication instructions.
  4. On the day of surgery, patient arrives at the hospital or surgical center and is prepped for the procedure.
  • During hand surgery:
  1. Patient receives local anesthesia using the WALANT technique, which involves a mixture of lidocaine and adrenaline.
  2. Surgeon performs the hand surgery, which may involve repairing tendons, nerves, or other structures in the hand.
  3. Patient is awake during the procedure and may be able to communicate with the surgeon.
  • After hand surgery:
  1. Patient is monitored in the recovery room for a period of time before being discharged.
  2. Patient receives post-operative instructions on how to care for their hand, including wound care and pain management.
  3. Patient may need to attend follow-up appointments with the surgeon to monitor healing and address any concerns.
  4. Patient undergoes physical therapy or rehabilitation to regain strength and function in the hand.

What to Ask Your Doctor

  1. What specific hand surgery procedure are you recommending for me?
  2. What are the potential risks and complications associated with this surgery?
  3. How long is the recovery period after this surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. What type of anesthesia will be used during the surgery?
  6. How experienced are you in performing this particular hand surgery?
  7. What is the success rate of this surgery for patients with a similar condition to mine?
  8. Are there any alternative treatments or procedures that I should consider before deciding on surgery?
  9. What can I expect in terms of pain management post-surgery?
  10. How often will I need to follow up with you after the surgery for monitoring and care?

Reference

Authors: Satkunabalan M, Khan R, Ng ZY. Journal: J Hand Surg Asian Pac Vol. 2024 Oct;29(5):458-466. doi: 10.1142/S2424835524500449. Epub 2024 Aug 30. PMID: 39205528