Work

Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Bier’s Block in the Internal Fixation of Unstable Distal Radius Fractures: A Single-Center Experience

Year: 2025

Type: article

Abstract: INTRODUCTION AND AIM: Unstable distal radius fractures typically necessitate surgical management through open reduction and internal fixation (ORIF). There are significant considerations and challenges regarding the selection of the anesthetic modality employed for the surgical management of these fractures. Recently, the wide-awake local anesthesia no tourniquet (WALANT) technique has been increasingly used for hand and wrist procedures, demonstrating excellent outcomes and fewer complications compared to general or regional anesthesia. This study aimed to compare the efficacy of the WALANT technique with Bier's block anesthesia in the fixation of unstable distal radius fractures. MATERIALS AND METHODS: Patient demographics, mechanism of injury, fracture type, and anesthesia type (Bier's block or WALANT) were recorded. Our study constitutes a retrospective comparative analysis between the two types of anesthesia employed. All fractures were fixed through the extensor carpi radialis approach using a palmar locking plate. Surgeries were performed within 10 days of injury (range: one to 15 days). Pain levels during injection (WALANT group), intraoperatively, and postoperatively were assessed using the visual analog scale (VAS). Additional parameters included duration of surgery, analgesic use, and preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). RESULTS: Fifty-one patients (mean age: 57.9 years; range: 41-73) underwent ORIF - 26 with Bier's block and 25 with WALANT. Mean intraoperative pain in the WALANT group was 1.48/10, with postoperative VAS 1/10, compared to 6/10 in the Bier's block group. APAIS scores were similar between groups (4.45 in WALANT versus 4.58 in Bier's block). WALANT patients were discharged the same day, while those with Bier's block were discharged the following day. Analgesic use was shorter in the WALANT group (2.3 days versus 5.7 days). Surgery duration was slightly longer with WALANT (60.1 versus 54.2 min). CONCLUSION: The use of WALANT offered lower pain scores, reduced analgesic use, and same-day discharge. Therefore, WALANT is recommended as the preferred anesthetic technique for unstable distal radius fracture fixation.

Source: Cureus

DOI: 10.7759/cureus.98826