WALANT

Under a WALANT anesthesia, ( acronym of the English W ide A wake L ocal A nesthesia N o T ourniquet German local anesthesia at the wide-awake patients without tourniquet ) refers to a relatively new process of the local anesthetic in the hand surgery without tourniquet on nichtsedierten patient, with the possibility of intraoperative active function test. This means that the operation can also be carried out on an outpatient basis.

execution

At least 30 minutes preoperatively, an infiltration of a lidocaine - adrenaline mixture (lidocaine 1% with epinephrine 1: 200,000) with 8.4% sodium bicarbonate added in a ratio of 10: 1.5 is administered. Bupivacaine 0.5% can optionally be given if the operation lasts more than 2.5 hours. Phentolamine is used to reverse the effects of epinephrine. The addition of sodium bicarbonate is an off-label ( off-label ) application, but its pH neutralization leads to a faster onset of action and avoids burning pain during the infiltration. The infiltration should be fractionated to reduce pain.

Examples

When splitting the carpal tunnel, the infiltration takes place 0.5 cm proximal to the wrist crease halfway between the tendons of the palmaris longus muscle and the flexor carpi ulnaris muscle .

origin

In 2003 Donald H. Lalonde first published this method of local anesthesia.

Indications

This procedure is most commonly used for carpal roof splits (see carpal tunnel syndrome ), ring ligament splits and splits of the first extensor tendon compartment (see Tendovaginitis stenosans de Quervain ). It is possible to carry out Tenolysen or motor replacement operations, thereby intraoperative active mobilization and monitoring is possible.

Individual evidence

↑ Donald H. Lalonde, Wide Awake Hand Surgery, Thieme Verlag, Stuttgart, 2016 ISBN 1-62623-662-3 .
↑ T. Nodwell, D. Lalonde: How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective, randomized, blinded study: The Dalhousie project experimental phase. In: The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique. Volume 11, number 4, 2003, pp. 187-190, doi : 10.1177 / 229255030301100408 , PMID 24009436 , PMC 3760747 (free full text).
↑ P. Kaiser, M. Keller, J. Dörler, G. Schmidle: Wide-awake technique in hand surgery based on application examples. In: Operative Orthopedics and Traumatology. 30, 2018, p. 195, doi : 10.1007 / s00064-018-0544-x .

[1] Donald H. Lalonde, Wide Awake Hand Surgery, Thieme Verlag, Stuttgart, 2016 ISBN 1-62623-662-3 .

[2] T. Nodwell, D. Lalonde: How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective, randomized, blinded study: The Dalhousie project experimental phase. In: The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique. Volume 11, number 4, 2003, pp. 187-190, doi : 10.1177 / 229255030301100408 , PMID 24009436 , PMC 3760747 (free full text).

[3] P. Kaiser, M. Keller, J. Dörler, G. Schmidle: Wide-awake technique in hand surgery based on application examples. In: Operative Orthopedics and Traumatology. 30, 2018, p. 195, doi : 10.1007 / s00064-018-0544-x .