A Prospective Study Comparing Wide-Awake Local Anesthesia No Tourniquet Versus General Anesthesia in Hand Fracture Fixation

Purpose

Fixation of metacarpal or phalanx bone fractures is usually performed under general anesthesia (GA) or regional anesthesia and with the use of a tourniquet to minimize bleeding. However, the use of tourniquet causes pain and discomfort after surgery. Wide-awake local anesthesia no tourniquet (WALANT) enables the surgery to be performed with the patient fully awake and without a tourniquet, which allows intraoperative assessment of function during surgery. This study aims to compare the perioperative parameters and clinical outcomes between GA versus WALANT in hand fracture fixations.

Methods

Forty-eight patients with hand fractures were recruited over a period of 15 months. Twenty-one patients had undergone fracture fixation under GA, whereas another 27 patients had the surgery under WALANT. Parameters including vital signs (heart rate and systolic blood pressure), surgery duration, estimated blood loss, visual analog scale, and quick disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire were evaluated.

Results

Wide-awake local anesthesia no tourniquet group had significantly higher systolic blood pressure values and higher estimated blood less than GA group. Wide-awake local anesthesia no tourniquet group also documented shorter surgical time compared with GA group, but the difference was not significant. In terms of clinical outcomes, WALANT group recorded significantly lower visual analog scale score at 2 hours and 2 weeks postsurgery. However, WALANT has a comparable QuickDASH score with GA group except at 3 months postsurgery.

Conclusions

Wide-awake local anesthesia no tourniquet surgery for hand fracture fixation provides a similar analgesic effect and comparable QuickDASH score except at 3 months postsurgery compared with GA.

Type of study/level of evidence

Therapeutic IIb.