Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults

Background: A considerable percentage of ER admissions which necessitates operative intervention are related to hand injuries specially flexor tendons. Operations on flexor tendon required perfect bloodless surgical field which can be achieved through using tourniquet under different anesthesia strategy; general anesthesia, Intravenous regional anesthesia brachial plexus block.... etc. Local anesthesia technique through Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique is also an alternative where patient kept awake which allow intraoperative assessment of repaired tendon & hemostasis provided by using adrenaline in the injected local anesthesia mixture. This study was designed to compare the use of WALANT versus supraclavicular brachial plexus block for flexor tendons repair regarding the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and Materials and Methods: 52 patients enrolled for hand flexor tendon repair were randomly divided into one of two groups (26 in each) either to receive WALANT or SC-BPB with tourniquet. Results: Intraoperative Wong-Baker Faces scale results for pain assessment were comparable in both groups, except during injection (p = 0.04) was higher in SC-BPB, while tourniquet-related pain was reported in 23% of patients of SC-BPB group (p =0.001). Induction time was significantly shorter in WALANT (p <0.01), time needed to obtain sufficient hemostasis was significantly longer in WALANT than SC-BPB (p <0.01) while surgical time was comparable in both groups (p = 0.538). higher blood loss was found in WALANT (p <0.01). Patients expressed higher level of satisfaction with WALANT technique (P value 0.032) & their wish to have same type of anesthesia if to undergo similar procedure in the future. Conclusion: WALANT anesthesia was found to be a good alternative to SC-BPB in flexor tendon repair surgeries in adults being technically simple, low cost & efficient technique. BPB still an acceptable technique specially when considerable blood loss is expected like when bone structure involved, or deep aggressive dissection is needed.