gms | German Medical Science

Objective: This study aims to compare the outcomes of plating distal radius fractures using WALANT and general anesthesia as we evaluate WALANT as an alternative anesthesia for this type of surgery.

Introduction: WALANT is being considered as an alternative anesthesia for fixation of fractures beyond the wrist such as distal radius fractures, which are classically performed under general anesthesia, because patients with acute cardiorespiratory problems or multiple chronic medical illnesses often experienced delay in fracture fixation until they are deemed medically fit for surgery under general anesthesia. As distal radius fracture is very common in the community, fixation of this fracture in a timely manner, is essential to enable patients to regain early full wrist function for continuation of their activities of daily living.

Methods: Five patients of various ages, comorbidities and with distal fracture requiring plating were recruited for fracture fixation using WALANT whilst another five patients underwent fracture fixation under general anesthesia. Outcomes observed and compared were waiting time for operation, patient's pain control and hemodynamics, estimated blood loss, occurrence of adverse effects of lignocaine with epinephrine and drugs used for general anesthesia and duration of post-operative stay.

Results: All patients in the WALANT group experienced mild to no pain during surgery and did not require conversion to general or regional anesthesia. None reported any adverse effects from lidocaine or epinephrine during and after surgery. Waiting time to operation was significantly shorter in the WALANT group. Blood losses were comparable to patients who used tourniquet during general anesthesia. Duration of post-operative stay at hospital was relatively shorter for WALANT group.

Conclusion: WALANT approach can be an alternative to general anesthesia for plating of distal radius fracture as it is able to provide patients with adequate pain relief, no adverse effects from lidocaine or epinephrine and good control of bleeding at the operation field thus resulting in a clear operative view for the surgeon. It is also potentially cost saving to both patient and healthcare provider as it obviates the need for pre-operative assessment and post-operative monitoring by the anesthetist and an overall shorter stay at the hospital.