Randomized Prospective Study Comparing Wide-Awake Local Anesthesia No Tourniquet (WALANT) and Locoregional Anesthesia in Minimally Invasive Hallux Valgus Surgery: Preliminary Results.

Abstract

Background: Minimally invasive techniques for hallux valgus correction, such as minimally invasive chevron Akin (MICA), are increasingly adopted and traditionally performed under locoregional anesthesia (LRA). The choice of anesthetic technique may influence perioperative outcomes, patient experience, and resource utilization. The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique has recently been introduced in foot surgery as a potential alternative.

Methods: A prospective, randomized, single-center study was conducted on 40 patients with mild to moderate hallux valgus undergoing correction with the MICA technique. Patients were randomized into 2 groups: LRA (n = 20) and WALANT (n = 20). The primary endpoint of this study was the assessment and comparison of intraoperative and postoperative pain at 24 hours between the WALANT and LRA groups. Secondary endpoint was the comparison of anesthetic time and recovery stay between the 2 techniques.

Results: Mean intraoperative and postoperative NRS pain scores showed no statistically significant differences between the 2 groups. The anesthesia time and the recovery stay were significantly shorter in the WALANT group compared with the LRA group. All WALANT procedures were successfully completed without anesthetic conversion.

Discussion: The application of WALANT in hallux valgus surgery meets the growing demand for efficient perioperative pathways, potentially improving operating room efficiency and reducing hospitalization time. In this preliminary study, no statistically significant difference in intraoperative or postoperative pain at 24 hours was detected between WALANT and LRA with the numbers available. These findings suggest that WALANT may represent a feasible anesthetic approach for MICA correction of hallux valgus.

Conclusion: In this prospective randomized study, no statistically significant difference in intraoperative or postoperative pain was detected between WALANT and locoregional anesthesia with the numbers available. WALANT was associated with shorter anesthesia time and recovery stay, suggesting that it may represent a feasible anesthetic option for MICA hallux valgus surgery. Further studies with larger cohorts are required to confirm these findings.

Level of evidence: Level II, prospective randomized trial.