Service de chirurgie plastique esthétique et reconstructrice, centre hospitalo-universitaire de Bordeaux, GH Pellegrin Centre François-Xavier Michelet, place Amélie-Raba-Léon, 33000 Bordeaux, France.
Hand Surg Rehabil. 2022 Sep;41(4):435-440. doi: 10.1016/j.hansur.2022.03.003. Epub 2022 Apr 26.
The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique uses local anesthesia based on lidocaine and adrenaline, enabling surgery without the tourniquet normally used in hand surgery. Only a few studies have been conducted on the use of WALANT for emergency hand surgery in teaching hospitals. We therefore set up the WALANT procedure in our emergency department in the university hospital of Bordeaux, France, to evaluate its feasibility and the satisfaction of patients and operators. Between April and June 2020, we included 58 patients undergoing surgery for acute trauma of the hand/wrist. WALANT was performed following a specific protocol. A tourniquet was systematically available on standby. After the procedure, patients and operators were asked to complete a questionnaire. Patients rated pain on a 0-10 numerical analog scale. Surgeons reported their feelings about bleeding and patient cooperation. All patients underwent a nearly painless operation, with a mean pain score of 0.36/10. The mean pain score during injection was 2.57, and postoperatively 5.2. Bleeding complications were reported to be absent or slight by 43% of operators, moderate but acceptable by 47%, and significant by 10%. Bipolar forceps were used in 76% of cases. No digital necrosis or prolonged ischemia requiring the use of phentolamine was reported. WALANT offers a simple, safe, and effective alternative to traditional anesthesia techniques in an emergency setting. Patients and surgeons reported overall satisfaction, with no increase in the complications rate.
清醒局部麻醉无止血带（WALANT）技术使用基于利多卡因和肾上腺素的局部麻醉，使手部手术无需使用通常使用的止血带。只有少数研究在手外科急症中使用 WALANT。因此，我们在法国波尔多大学医院的急诊部门设立了 WALANT 程序，以评估其可行性和患者和操作人员的满意度。2020 年 4 月至 6 月期间，我们纳入了 58 名接受手部/腕部急性创伤手术的患者。WALANT 是按照特定的方案进行的。止血带系统备用。手术后，患者和操作人员被要求完成一份问卷。患者使用 0-10 数字模拟量表对疼痛进行评分。外科医生报告他们对出血和患者合作的感受。所有患者均接受了几乎无痛的手术，平均疼痛评分为 0.36/10。注射时的平均疼痛评分为 2.57，术后为 5.2。43%的操作人员报告出血并发症轻微或无，47%的操作人员报告中度但可接受，10%的操作人员报告严重。在 76%的情况下使用了双极止血钳。没有报告出现手指坏死或需要使用酚妥拉明的长时间缺血。WALANT 在紧急情况下为传统麻醉技术提供了一种简单、安全、有效的替代方案。患者和外科医生报告总体满意度高，并发症发生率没有增加。
