Wide-Awake Local Anesthesia No Tourniquet in Adolescent Hand Surgery: A Systematic Review

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-08-29 DOI:10.1016/j.jhsg.2025.100820

Hannah Polley BMSc , Benjamin Blackman BHSc , John Tristan Cassidy MBBCh, MCh , Johan van der Stok MD, PhD

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Abstract

Purpose

Wide-awake local anesthesia no tourniquet (WALANT) allows for intraoperative assessment of function while minimizing systemic anesthesia effects and is frequently used in adult hand surgery. However, the safety and feasibility of WALANT in adolescents remains uncertain because of potential challenges with adherence and cooperation. This review aimed to compile the evidence for using WALANT in adolescents.

Methods

PubMed, Medline, Embase, and Scopus were searched from inception to December 2024. Comparative and cohort studies were included. Outcomes, including procedure time, length of hospital stay, and pain scores, were analyzed. Because of the heterogeneity of outcomes investigated, a narrative review was performed.

Results

Four studies, three case-control studies (n = 287) and one case series (n = 6), involving 166 WALANT surgeries were included. The mean age across all patients, including WALANT and control, was 14, with a range of 7–20 years old. The most common WALANT procedures were tendon repair (22.3%, n = 37) and ganglion removal (22.3%, n = 37), followed by digital nerve repair (18.1%, n = 30). One conversion (0.6%) to a general anesthetic was reported.

Conclusions

Current evidence on the utilization of WALANT in adolescents is limited; WALANT may reduce procedure time, length of hospital stay, and improve pain scores.

Type of study/level of evidence: Therapeutic IV.

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青少年手外科全清醒局麻无止血带：系统回顾

目的：广泛清醒局麻无止血带（WALANT）允许术中功能评估，同时最大限度地减少全身麻醉的影响，经常用于成人手外科手术。然而，青少年WALANT的安全性和可行性仍然不确定，因为在依从性和合作方面存在潜在的挑战。本综述旨在收集在青少年中使用WALANT的证据。方法检索spubmed、Medline、Embase和Scopus数据库，检索时间为建站至2024年12月。包括比较研究和队列研究。结果包括手术时间、住院时间和疼痛评分。由于调查结果的异质性，我们进行了叙述性回顾。结果纳入4项研究，3项病例对照研究（n = 287）和1个病例系列研究（n = 6），涉及166例WALANT手术。包括WALANT和对照组在内的所有患者的平均年龄为14岁，年龄范围为7-20岁。最常见的WALANT手术是肌腱修复（22.3%,n = 37）和神经节切除（22.3%,n = 37），其次是指神经修复（18.1%,n = 30）。据报道，1例（0.6%）转为全麻。结论目前关于青少年使用WALANT的证据有限；WALANT可以缩短手术时间，缩短住院时间，改善疼痛评分。研究类型/证据水平：治疗性IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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