WALANTWide Awake Local

Anaesthetic No Tourniquet

Mr. Anthony BarabásConsultant Plastic & Hand Surgeon

Hinchingbrooke Hospital, Cambridgeshire, UK

What is WALANT?

W ideA wakeL ocalA naesthesiaN oT ourniquet

The Future…..?

11th Commandment:“Thou shalt not use adrenaline in

the hand”

Sterling Bunnell“The father of hand

surgery”

• used procaine, -short shelf life tissue necrosis

↑ bleeding after releasing the tourniquet:

- Reflex hyperaemia

- compromised clotting from local acidosis

Advantages of WALANT1. Saves time

2. Less postop pain

3. Less postop bleeding - No need to stop anticoagulants

4. Improved outcomes with patient interaction : tendon surgery

5. Cost savings

X

Warming Local Anaesthetics

Yiannakopoulis CK. Carpal tunnel decompression under local anaesthesia: The effect of lidocaine warming and alkanisation on infiltration pain. JHS (Br). 2004;29:32-34

pH No Adren + Adren

1% 6.09 4.24

2% 6.00 3.93

• Tissue pH = 7.3 - 7.6

20ml 2ml

• Multicentre trial, 6 surgeons• 1504 CTD over 2 years• Minor treatment room setting• Field sterility + LA• 1-2 week f/u• Superficial infection - 0.6%• Deep infection - 0

CTD disposables

From Operationtheatre

From Minor Treatmentroom

Conc: Higher monetary and environmental cost can not justify CTD to be preformed in main operating theatres

http://www.weds.wales.nhs.uk/operating-department-practitioners

Summary

• Increased productivity• Improved patient safety• Improved patient outcomes• Treatment room (office) based• Huge cost savings

Thanks for listeningAny questions?