AB145. SOH25_AB_162a. Wide-awake local anaesthesia no tourniquet in adolescent hand surgery: a systematic review
Orthopaedic Session II

AB145. SOH25_AB_162a. Wide-awake local anaesthesia no tourniquet in adolescent hand surgery: a systematic review

Hannah Polley1, Benjamin Blackman1, Johan van der Stok2

1Faculty of Education & Health Services, School of Medicine, University of Limerick, Limerick, Ireland; 2Department of Trauma & Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland

Background: Wide-awake local anaesthesia no tourniquet (WALANT) is widely utilised in hand surgery. WALANT allows intraoperative assessment of function, reduces anaesthesia effects, and improves pain control. Evidence is needed to determine its utility in adolescents, as WALANT may enable an earlier return to school.

Methods: PubMed, Medline, Embase, and Scopus were searched from inception to September 2024. Comparative and cohort studies were included. Outcomes including procedure time, length of hospital stay (LOS), and pain scores were analysed. Due to the heterogeneity of outcomes investigated, a narrative review was performed.

Results: Three studies, including two case controls (n=125) and one cohort (n=6), involving 131 patients were included. The mean age was 14.3 and 13.3 years in the WALANT and control group, respectively. The operations were performed in hospital and outpatient clinics. The most common WALANT procedure was tendon repair (40%, n=22). One patient required conversion to general anaesthesia (0.76%). In one study, WALANT was preferred in 87.5% of followed-up patients. In WALANT patients, the average pain score from the local injection and procedure was 0.8/10 and 0.4/10, respectively. Another study found that compared to control, WALANT reduced procedure time from 61 to 52 minutes, and LOS from 342 to 222 minutes.

Conclusions: Current evidence on the utilisation of WALANT in adolescents remains limited. This technique requires a personalised approach to ensure patient compliance. This review showed WALANT may reduce procedure time, LOS, and improve pain scores. Further research is needed to elucidate the utility of WALANT in adolescents.

Keywords: Adolescent; hand; local; surgery; wide-awake local anaesthesia no tourniquet (WALANT)

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab145
Cite this abstract as: Polley H, Blackman B, van der Stok J. AB145. SOH25_AB_162a. Wide-awake local anaesthesia no tourniquet in adolescent hand surgery: a systematic review. Mesentery Peritoneum 2025;9:AB145.

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