Gustavo Lucar-Lopez^1,4, Guillem Paz Ramírez¹, Maria Fernanda Gómez Blanco¹, Manel Ballester-Alomar^1,4*, Kerbi Alejandro Guevara-Noriega³ and MA Villamizar Avendaño²

¹Orthopaedic Surgery Department, Hospital de Mataro, Mataro, Spain

*Corresponding Author: Manel Ballester-Alomar, Orthopaedic Surgery Department, Hospital de Mataro, Mataro, Spain and Foot and ankle and Sports Medicine Unit, Clinica Creu Blanca, Barcelona.

Received: July 14, 2022; Published: August 12, 2022

Abstract

Forefoot surgery usually requires tourniquet use and anaesthesia is performed using a popliteal or ankle anaesthetic block. Therefore, surgical departments require an anaesthesiologist to trust them with this procedure. The elective nature of forefoot surgery and the lack of anaesthesiologists resulting from the COVID 19 pandemic, has forced Foot and Ankle specialists to dig into other alternatives, in order to continue their surgical practice and to avoid the growth of the waiting list. The wide-awake local anaesthesia non-tourniquet, which was originally described for upper limb surgery, has recently been adjusted to Foot and Ankle surgery. It does not require sedation, nor regional or general anaesthesia and since the patient is wide-awake, they will be able to fully collaborate during the procedure. The use of lidocaine and adrenaline described on the WALANT technique allows us to obtain a local anaesthesia and vasoconstriction. This method permits the surgeon to move forward into surgery with a completely awake patient and no need of tourniquet giving the advantage of a full motor function assessment intraoperatively. WALANT has been proven to be a safe, effective and affordable technique when it comes to foot and ankle surgery. Having gone through a lack of anaesthesiologists, surgery rooms and hospital resources during SARS-CoV2, WALANT emerged and now represents an acceptable alternative to consider and continue to treat selected cases of foot and ankle surgeries.

Keywords: WALANT; Foot and Ankle; Local Anaesthesia; COVID-19; Ambulatory Surgery; Forefoot Surgery

References

1. Vadivelu N., et al. “Role of regional anesthesia in foot and ankle surgery”. Foot and Ankle Specialist 3 (2010): 212-219.
2. Guevara-Noriega KA., et al. “Coagulation Panel in Pa-tients with SARS-CoV-2 Infection (COVID-19)”. Annals of Clinical and Laboratory Science 3 (2020): 295-298.
3. Lalonde D. “Minimally invasive anesthesia in wide awake hand surgery”. Hand Clinics 1 (2014): 1-6.
4. Abdullah S., et al. “Wide Awake Local Anesthesia No Tourniquet Forearm Triple Tendon Transfer in Radial Nerve Palsy”. Plastic and Reconstructive Surgery-Global Open 8 (2020): e3023.
5. Hagert E and Lalonde D. “Time to bury the adrenaline-myth! --Safe use of adrenaline anesthesia in hand surgery and orthopedics”. Lakartidningen 112 (2015): C4MC.
6. Mckee DE., et al. “Achieving the optimal epinephrine effect in wide awake hand surgery using local anesthesia without a tourniquet”. Hand (N Y)4 (2015): 613-617.
7. Bilgetekin YG., et al. “The use of the wide-awake local anesthesia no tourniquet technique in foot and ankle injuries”. Foot and Ankle Surgery S1268-7731.20 (202): 30141-30147.
8. Poggetti A., et al. “A local anesthesia without tourniquet for distal fibula hardware removal after open reduc-tion and internal fixation the safe use of epinephrine in the foot. A randomized clinical study”. Journal of Biological Regulators and Homeostatic Agents 326-1 (2018): 57-63.

Citation

Citation: Manel Ballester-Alomar., et al. “Description of WALANT Technique on Forefoot Surgery". Acta Scientific Orthopaedics 5.9 (2022): 56-58.

Copyright

Copyright: © 2022 Manel Ballester-Alomar., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.