gms | German Medical Science

Objectives/Interrogation: The aim of this study is to confirm the utility, safety and benefits of using WALANT technique and to encourage its use in Romania and all over the world for as many different hand and wrist surgeries as possible.

Methods: The study was conducted in a group of 75 patients admitted to our institution starting with January 2017. We included in the study 40 men and 35 women (M/F ratio = 1.14) aged 24 to 76 years. They accounted for 25% of the group of patients with carpal tunnel syndrome (CTS) and 35.71% of the group of patients diagnosed with Dupuytren Disease (DD). The anesthetic used in all cases was a solution of lidocaine 1% with 1:100,000 epinephrine without buffering it with 8.4% sodium bicarbonate. The amount of anesthetic solution used did not exceed 20 mL for CTS and 15 mL for each digital ray affected by DD. Onset of anesthesia took 6 to 15 minutes, being checked by subjective testing of the patient and by monitoring for skin color change at the injection site.

Results: No changes in digital vasculature were found in any of these cases. Hospital stay was of at least 6 hours (due to the lack of infrastructure and a legal system for short-term hospitalization). Only one patient stayed in hospital for 48 hours, the patient being diagnosed with neglected high values essential hypertension and oscillations. The correlation coefficient between the amount of anesthetic and number of digital rays affected by DD is 0.63, for p = 0.0002 (Significance F <0.001), showing a positive, direct and high correlation. Therefore, the significant statistical results can be extrapolated to larger groups. Regression (ANOVA) shows a positive, moderate and direct correlation between the duration of hospitalization and the amount of the anesthetic used in CTS patients, with a correlation coefficient of 0.52, statistically significant with p<0.01 (Significance F=0.002). Applying regression in ANOVA, correlating the amount of anesthetic used to the entire group with the anesthesia onset time we get a correlation coefficient of 0.43, showing a moderate correlation, but high statistically significant, for p<<0.00001.

Conclusions: The use of WALANT technique in hand surgery is safe and efficient, has many advantages for both the patient and the surgeon and is cost-saving. Complications such as digital necrosis are excluded when 1% lidocaine with 1:100,000 epinephrine anesthetic solution not exceeding the safe zone of 7mg/kg is used.