Wide-awake local anesthesia, no tourniquet may not be superior to general anesthesia
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BOSTON — The wide-awake local anesthesia no tourniquet technique may not be superior to general anesthesia in regard to function, rates of rupture and patient-reported outcomes, according to results presented here.
“We believe that surgeons can be confident in choosing either technique as long as rigorous patient selection, sound surgical technique and proper hand therapy have been sought,” Mohamed Morsy, MD, said in his presentation at the American Society for Surgery of the Hand Annual Meeting.
Morsy and colleagues randomly assigned patients undergoing flexor tendon laceration repair at zone 2 to receive surgery with either the wide-awake local anesthesia no tourniquet technique (WALANT; n=43) or general anesthesia (n=40).
“Our primary outcome was range of motion using the Strickland and Glovac original criteria measured with a finger goniometer,” Morsy said. “Secondary outcomes included ruptures, complications and DASH scores all measured at the 6-month endpoint.”
Morsy noted the WALANT group and the general anesthesia group did not have statistically significant differences in the percentage of excellent or good outcomes according to Strickland and Glovac criteria, with excellent or good outcomes identified in 49% of digits in the WALANT group and 56% of digits in the general anesthesia group.
Both groups had similar rupture rates, according to Morsy. Although patients in the WALANT group had slightly higher DASH scores (12.9 vs. 8.4), Morsy noted the difference between the groups was “not big enough to give clinical significance.” He added complications between the two groups were also similar.
“The WALANT group had three patients with wound problems, one which required surgical debridement; seven flexion deformities of the [proximal interphalangeal] PIP joint and one isolated tendon adhesion with full, passive range of motion,” Morsy said. “The general anesthesia group had three patients with wound problems, two of which required surgical debridement; six flexion deformities of the PIP joint and one tendon adhesion.”
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Morsy M, et al. Paper 03. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 29 - Oct. 1, 2022; Boston.
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