Artikel
Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Local or Intravenous Regional Anesthesia with Tourniquet In Elective Hand Surgeries: A Systematic Review And Meta-Analysis
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Autoren
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Ted Matthew P. Evangelista
- University of Santo Tomas Hospital, Manila, Philippines
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John Hubert C. Pua
- University of Santo Tomas Hospital, Manila, Philippines
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Mara Therese E. Huber
- Levana Dermatology Clinic, Quezon City, Philippines
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The WALANT technique is gaining popularity over the use of tourniquets in elective orthopaedic hand surgeries as it eliminates the complications associated with general or intravenous regional anaesthesia and the discomfort associated with tourniquets.
The objective of this study is to compare the efficacy, safety and patient satisfaction of the WALANT procedure versus local or intravenous regional anaesthesia with tourniquet in atraumatic hand surgeries.
Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and the Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anaesthesia or intravenous regional anaesthesia with tourniquet among atraumatic, elective hand surgeries such as carpal tunnel release, tendon sheath incision, and excision of baker's cyst were included. Methodological quality, risk of bias, and GRADE of the eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity of the studies.
Results and Conclusions: The search yielded 70 records, of which 9 studies were included in the systematic review. In our interim analysis, we were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative times by 2.06 minutes (pooled mean difference, random effects, 95% CI 0.46 to 3.67 mins, p = 0.01, I2 0%, p = 0.66). The post-operative pain scores were lower in the WALANT group by an average of two VAS points (random effects, pooled mean difference -2.40, 95% CI -3.41 to -1.38, p < 0.00001; I2 0% p = 0.99). We had insufficient evidence to demonstrate a difference in terms of patient satisfaction (random effects, pooled RR 0.98, 95% CI 0.93 to 1.03, p = 0.36, I2 0%, p = 0.64) and complication rates (random effects, pooled RR 0.40, 95% CI 0.07 to 2.18, p = 0.29, I2 60% p = 0.08) between WALANT versus conventional methods.
The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates.
