WALANT vs standard anaesthesia in the management of flexor tendon injuries: A systematic review and meta-analysis.

Wide awake local anaesthesia no tourniquet (WALANT) surgery has gained increasing popularity in recent years for hand surgery fast-tracked by the COVID pandemic. It involves infiltration of lidocaine with adrenaline to the operative region ensuring a good visual field owing to the vasoconstrictive effects of epinephrine. It has numerous advantages over traditional anaesthetic (TA) for flexor tendon repairs including testing of tendon strength on table as well as immediate revision of the repair if needed. Currently there are a number of studies in the literature evaluating WALANT versus TA in flexor tendon injuries with continuing debate on the optimal modality but no amalgamated synthesis of data. The authors report the first systematic review and meta-analysis on the topic. The authors conducted the review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA) guidelines. All studies comparing flexor tendon repairs under WALANT versus TA were included. The primary outcome measure was range of movement (ROM) with secondary outcomes including adhesions/tenolysis, rupture as well as re-operation rates. OpenMeta[Analyst] software was utilised for data synthesis. Five studies in total met the inclusion criteria with an overall assessment of 624 fingers. There was no significant difference observed between WALANT and TA for tendon rupture; odds ratio 1.027 (0.450, 2.342) p-value = 0.950, the incidence of adhesions/tenolysis; odds ratio 0.601 (0.172, 2.093) p-value = 0.424 or re-operation rates; odds ratio 1.193 (0.544, 2.618) p-value = 0.659. ROM was reported to be better in the WALANT cohort; odds ratio: 1.641 (1.010, 2.669) p-value = 0.046. WALANT offers a safe and effective mode of anaesthetic over traditional modalities with comparable outcomes for flexor tendon repairs. Although ROM appears superior, the number of randomised control trials are currently low and more high quality studies are necessitated to enhance the current evidence base.