Experience in the surgical treatment of Dupuytren's disease using WALANT anesthesia.

Abstract

Fasciectomy is a surgical procedure frequently used for the treatment of Dupuytren's disease. The WALANT (Wide-Awake Local Anesthesia No-Tourniquet) anesthesia technique has gained popularity for its advantages over general anesthesia, such as risk reduction and cost savings. However, one of the main challenges is pain management and anesthetic efficacy during surgery. This study aims to evaluate the feasibility of this technique in pain management, patient experience, and cost savings in surgery for Dupuytren's disease. Prospective study that included patients treated surgically for Dupuytren's disease under WALANT anesthesia. Clinical history, number of affected fingers, and joint contracture were recorded, classifying them according to Tubiana. Anesthesia consisted of a mixture of 20 ml of 2 % lidocaine with epinephrine, 20 ml of 0.5 % bupivacaine, and 40 ml of saline solution, administered by ulnar nerve block and over the area of the cord to be resected, without using a hemostatic cuff. Variables such as pain during infiltration and surgical procedure, anxiety, surgery time, postoperative range of motion, and incidence of complications and recurrences were evaluated. The data were analyzed using descriptive methods and statistical analysis. 17 patients were prospectively evaluated. 64.7 % of patients managed to recover a full range of motion in the first four postoperative weeks, while 35.2 % had a partial range. Immediate complications were minimal, with only 5.8 % of patients developing local infections or minor hematomas, successfully resolved with conservative treatment. The recurrence rate was 11.7 % at six months. A cost analysis showed that the use of WALANT resulted in a cost saving of 60.6 % compared to general or regional anesthesia, making the technique an attractive option in healthcare systems with limited resources. The study reveals that the WALANT anesthetic technique for surgery for Dupuytren's disease provides effective pain management both during the injection and during the surgical procedure. This technique facilitates a relatively quick and comfortable recovery, offering an overall positive experience for patients. results suggest that WALANT may be an effective and precise option for the surgical procedure in Dupuytren's disease, with advantages in terms of pain control, cost savings, and favorable postoperative outcomes. Furthermore, it allows surgeons and patients to obtain immediate feedback on the dynamic outcome of cord release, which may improve subsequent dissection and rehabilitation.