Comparison of Wide-Awake Local Anaesthesia without Tourniquet (WALANT) and Infraclavicular Brachial Plexus Block in the Plating of Distal Radius Fractures

Abstract

Objective

We hypothesised that the WALANT technique can be consistently replicated and does not demand a high level of skill, and it leads to a higher patient satisfaction rate, improved clinical outcomes, and shorter waiting times compared with an IC-BP block.

Methods

Forty-eight patients with isolated closed DRF were randomly assigned to the WALANT or IC-BP group. Demographic data, fracture classification, suitability for surgery, preoperative pain scores, and waiting times were collected prospectively. Perioperative parameters, clinical outcomes (pain scores, Disabilities of the Arm, Shoulder and Hand [DASH] scores), complications, patient satisfaction (Visual Analogue Patient Satisfaction [VAPS] scale), and return to work were assessed.

Results

Patients in the WALANT group had significantly shorter waiting times for surgery and postoperative hospital stays than the IC-BP group. No significant difference was found in intraoperative blood loss. The WALANT group had lower pain scores at postoperative weeks 2, 6, and 12. DASH scores improved over time in both groups, with the WALANT group having a significantly lower mean score during the follow-up period. Patients in the WALANT group returned to work earlier, and patient satisfaction was significantly higher.

Conclusion

Compared with IC-BP blockade, the WALANT technique offers several advantages in DRF surgery, including shorter waiting times, shorter postoperative hospital stays, lower pain scores, better functional outcomes, faster return to work, and higher patient satisfaction. The WALANT technique offers a safe and effective alternative that eliminates the need for general anaesthesia or tourniquet application. This technique is suitable for DRF surgery because it provides consistent results and does not require a high level of expertise. Further studies with larger sample sizes are needed to confirm these results and investigate long-term outcomes.

Zusammenfassung

Hintergrund

Wir gingen von der Hypothese aus, dass die WALANT-Technik konsistent reproduziert werden kann, kein hohes Maß an Können erfordert und zu einer höheren Patientenzufriedenheit, besseren klinischen Ergebnissen und kürzeren Wartezeiten als der IC-BP-Block führt.

Materialien und Methoden

48 Patienten mit isolierter geschlossener DRF wurden nach dem Zufallsprinzip der WALANT-Gruppe oder der IC-BPGruppe zugewiesen. Demografische Daten, Frakturklassifizierung, Eignung für eine Operation, präoperative Schmerzwerte und Wartezeiten wurden prospektiv erhoben. Perioperative Parameter, klinische Ergebnisse (Schmerzwerte, Werte für Behinderungen von Arm, Schulter und Hand [DASH]), Komplikationen, Patientenzufriedenheit (Skala für visuelle analoge Patientenzufriedenheit [VAPS]) und Wiedereinstieg ins Berufsleben wurden bewertet.

Ergebnisse

Patienten der WALANT-Gruppe hatten im Vergleich zur IC-BP-Gruppe deutlich kürzere Wartezeiten für Operationen und postoperative Krankenhausaufenthalte. Es wurde kein signifikanter Unterschied beim intraoperativen Blutverlust festgestellt. Die WALANT-Gruppe hatte in den postoperativen Wochen 2, 6 und 12 niedrigere Schmerzwerte. Die DASH-Werte verbesserten sich im Laufe der Zeit in beiden Gruppen, wobei die WALANT-Gruppe während des Nachbeobachtungszeitraums einen signifikant niedrigeren Durchschnittswert hatte. Patienten der WALANT-Gruppe kehrten früher an ihren Arbeitsplatz zurück und die Patientenzufriedenheit war deutlich höher.

Schlussfolgerungen

Im Vergleich zur IC-BP-Blockade bei DRF-Operationen bietet die WALANT-Technik mehrere Vorteile, darunter kürzere Wartezeiten, kürzere postoperative Krankenhausaufenthalte, niedrigere Schmerzwerte, bessere funktionelle Ergebnisse, schnellere Rückkehr zur Arbeit und höhere Patientenzufriedenheit. Die WALANT-Technik bietet eine sichere und wirksame Alternative, die eine Vollnarkose oder das Anlegen einer Blutsperre überflüssig macht. Diese Technik eignet sich für DRF-Operationen, da sie konsistente Ergebnisse liefert und kein hohes Maß an Fachwissen erfordert. Weitere Studien mit größeren Stichproben sind erforderlich, um diese Ergebnisse zu bestätigen und langfristige Ergebnisse zu untersuchen.

Keywords

distal radius fracture - WALANT - wide-awake local anaesthesia - tourniquet - epinephrine - lidocaine

Schlüsselwörter

distale Radiusfrakturen - locale Anästhesie im Wachzustand

Publication History

Received: 16 October 2024

Accepted: 23 February 2025

Article published online:
02 July 2025

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