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      Use of Wide-Awake Local Anaesthetic No Tourniquet (WALANT) in upper limb and hand surgery: A systematic review protocol

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          Highlights

          • Analysing the benefits of Wide-Awake Local Anaesthetic, No Tourniquet in upper limb surgery.

          • Over 40 WALANT papers published since the last systematic review.

          • Systematic review compliant with the PRISMA guidelines.

          Abstract

          Introduction

          Wide Awake Local Anaesthetic No Tourniquet (WALANT) technique has been developed to eliminate tourniquet pain during upper limb and hand surgery whilst also improving utilisation of operating theatre time and inpatient stay, however inconclusive data still limits the techniques uptake. Here presents a protocol for a systematic review to collate findings to produce conclusive data on efficacy of WALANT.

          Methods

          This systematic review will be registered a priori. All study designs defined by the Oxford Centre for Evidence-Based Medicine will be included in the search. “WALANT” in “upper limb” and “hand” surgery will be investigated as per the devised search strategy. 18 electronic databases will be searched, including PubMed, Medline and Embase in addition to a Grey literature search. Two independent teams of 3 researchers will screen all relevant titles, abstracts and subsequent full texts for suitability. Data will be extrapolated and entered into a preformatted database for analysis.

          Ethics and dissemination

          This systematic review will be published in a peer-reviewed journal and presented at both national and international conferences within the field of plastic and orthopaedic surgery. This review aims to inform surgical practice and policy.

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          Most cited references15

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          Pain assessment.

          Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery. Pain intensity, pain-related disability, pain duration and pain affect are the aspects that define pain and its effects. For each of these aspects, different assessment instruments exist and are discussed in terms of advantages and disadvantages. Risk factors for the development of chronic pain have been a major topic in pain research in the past two decades. Now, it has been realised that psychological and psychosocial factors may substantially influence pain perception in patients with chronic pain and thus may influence the surgical outcome. With this background, pain acceptance, pain tolerance and pain-related anxiety as factors influencing coping strategies are discussed. Finally, a recommendation for a minimum as well as for a more comprehensive pain assessment is given.
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            Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures.

            Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room.
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              Latest Advances in Wide Awake Hand Surgery

              Injection of tumescent local anesthesia should no longer be painful. WALANT anesthesia, strong sutures, a slightly bulky repair, intraoperative testing of active movement, and judicious venting of the A2 and A4 pulleys improve results in flexor tendon repair. WALANT K wire finger fracture reduction permits intraoperative testing of K wire stability with active movement to facilitate early protected movement at 3 to 5 days after surgery. WALANT can decrease costs and garbage production while increasing accessibility and affordability. Several surgeons have found no infection difference when the K wires are inserted with full operating room sterility versus field sterility.
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                Author and article information

                Contributors
                Journal
                Int J Surg Protoc
                Int J Surg Protoc
                International Journal of Surgery Protocols
                Elsevier
                2468-3574
                13 March 2020
                2020
                13 March 2020
                : 20
                : 8-12
                Affiliations
                Bart’s and the London School of Medicine and Dentistry, London, UK
                Imperial College School of Medicine, London, UK
                St George’s University of London, London, UK
                University of Southampton, Southampton, UK
                Southend Hospital, Southend-On-Sea, UK
                Oxford University Hospital, Oxford, UK
                University College London Medical School, London, UK
                Royal London Hospital, London, UK
                Author notes
                [* ]Corresponding author at: Imperial College School of Medicine, South Kensington, London SW7 2AZ, UK. Ali.abdall-razak@ 123456outlook.com
                Article
                S2468-3574(20)30007-3
                10.1016/j.isjp.2020.03.001
                7125343
                32258835
                4db33fb9-fd54-4ce4-bdc1-bd982c65fc8b
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 3 February 2020
                : 2 March 2020
                Categories
                Research Paper

                walant,hand,limb,plastic,orthopaedic,surgery
                walant, hand, limb, plastic, orthopaedic, surgery

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