Efficiency of the combination of Wide Awake Local Anesthesia No Tourniquet (WALANT) and sciatic nerve block for Achilles tendon repair: A preliminary study of feasibility.

Background: Various anesthetic techniques are available for surgical repair of Achilles tendon rupture. The main limitation of peripheral nerve blocks is the risk of failure that can be attributed to the failure of the "tourniquet" block or of the "surgical" block.

Purpose: This retrospective study assessed the feasibility and the reproducibility of the association of WALANT technique to sciatic nerve block for Achilles tendon repair surgery.

Study design: Data from 34 adult patients scheduled for Achilles tendon repair were collected retrospectively from January 2022 to April 2023.

Methods: Sciatic nerve block (15 ml of Ropivacaine 0.375 %) and WALANT (30 ml of lidocaine 1 % with epinephrine) were performed under ultrasound guidance 30 minutes before surgery. A pneumatic thigh tourniquet was applied but not inflated. The primary endpoint was the efficiency of the combination of sciatic nerve block and WALANT, defined by anesthetic and hemostasis qualities.

Results: Efficacy of the combination of sciatic nerve block and WALANT was 91.2 %: one patient required sedation due to pain during skin incision (percutaneous technique), and two others due to discomfort. The hemostatic quality of WALANT was appropriate in 100 % of cases, no pneumatic tourniquet was required.

Conclusion: The combination of sciatic nerve block and WALANT infiltration provides an efficient and reproducible technique for the Achilles tendon repair. It avoids the need for a pneumatic tourniquet and limits the risk of peripheral nerve block failure.