{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:21:37Z","timestamp":1792416097936,"version":"4.4.0"},"reference-count":19,"publisher":"Universa BV","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Orthop Belg"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>Wide-awake local anesthesia and no tourniquet (WALANT), first used for hand surgery, has been sparingly described for use in fracture fixation of the upper limb. We present our experience using this technique. 26 patients with upper limb fractures (3 distal radius, 6 radial shaft, 11 ulnar shaft, and 6 olecranon fractures) were operated on using WALANT by three orthopedic surgeons. We used 35-40ml of 2% Lignocaine with 1:80000 Adrenaline(7mg\/kg) diluted with normal saline. Numeric Pain Rating (NPR) scoring was done during injection and per-operatively, and the Likert scale was used for the surgeon\u2019s satisfaction. The average NPR score was reported as 0.65 (1-3) during injection and 0.15 (0-2) preoperatively. All three surgeons reported excellent satisfaction in all the cases operated on. No complication occurred due to anesthesia. WALANT is a much simpler option and can be safely used in place of general anesthesia or regional blocks for fixation of fractures of the upper limb, with added advantages of no need for a tourniquet and better intraoperative assessment of fracture fixation.<\/jats:p>","DOI":"10.52628\/89.3.11357","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T20:56:40Z","timestamp":1699390600000},"page":"547-550","source":"Crossref","is-referenced-by-count":6,"title":["Wide-awake local anesthesia and no tourniquet (WALANT) in upper limb fractures"],"prefix":"10.52628","volume":"89","author":[{"given":"N","family":"BANSAL","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"TIWARI","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"DEV","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"27062","published-online":{"date-parts":[[2023,11]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Lalonde DH. Wide Awake Hand Surgery. 2016. Accessed December 28, 2021. https:\/\/medone-plasticsurgery.thieme.com\/ebooks\/1957501","DOI":"10.1055\/b-0037-142171"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Lalonde D. Wide awake local anaesthesia no tourniquet technique (WALANT). BMC Proc. 2015; 9(S3):A81, 1753-6561-9-S3-A81.","DOI":"10.1186\/1753-6561-9-s3-a81"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Lalonde D, Martin A. Tumescent Local Anesthesia for Hand Surgery: Improved Results, Cost Effectiveness, and Wide- Awake Patient Satisfaction. Arch Plast Surg. 2014; 41(4): p.312.","DOI":"10.5999\/aps.2014.41.4.312"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake Local Anesthesia with No Tourniquet: An Updated Review. Plastic and Reconstructive Surgery - Global Open. 2021; 26;9(3): p.e3507.","DOI":"10.1097\/gox.0000000000003507"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Lin Y-C, Chen W-C, Chen C-Y, Kuo S-M. Plate osteosynthesis of single metacarpal fracture: WALANT technique is a cost- effective approach to reduce postoperative pain and discomfort in contrast to general anesthesia and wrist block. BMC Surg. 2021; 9;21(1): p.358.","DOI":"10.1186\/s12893-021-01362-5"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Chung S-R, Lee EY, Tan DMK. Corrective Osteotomies for Digital Overlap in Phalangeal and Metacarpal Fracture Malunion Using Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique: A Technical Note. J Hand Surg Asian Pac. 2021; 26(3): p.485-9.","DOI":"10.1142\/s2424835521710028"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Feldman G, Orbach H, Rinat B, Rozen N, Rubin G. Internal fixation of metacarpal fractures using wide awake local anesthesia and no tourniquet. Hand SurgRehabil. 2020; 39(3): p.214-7.","DOI":"10.1016\/j.hansur.2020.01.003"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Ahmad AA, Yi LM, Ahmad AR. Plating of Distal Radius Fracture Using the Wide-Awake Anesthesia Technique. J Hand Surg Am. 2018; 43(11): p.1045.e1-1045.e5.","DOI":"10.1016\/j.jhsa.2018.03.033"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Huang Y-C, Hsu C-J, Renn J-H, Lin K-C, Yang S-W, Tarng Y-W, et al. WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet. J OrthopSurg Res. 2018; 6;13(1): p.195.","DOI":"10.1186\/s13018-018-0903-1"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Orbach H, Rozen N, Rubin G. Open reduction and internal fixation of intra-articular distal radius fractures under wide- awake local anesthesia with no tourniquet. J Int Med Res. 2018; 46(10): p.4269-76.","DOI":"10.1177\/0300060518793036"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Abitbol A, Merlini L, Masmejean EH, Gregory T. Applying the WALANT technique to surgical treatment of distal radius fractures. Hand SurgRehabil. 2021; 40(3): p.277-82.","DOI":"10.1016\/j.hansur.2021.02.001"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Ahmad AA, UbaidahMustapa Kamal MA, Ruslan SR, Abdullah S, Ahmad AR. Plating of clavicle fracture using the wide-awake technique. Journal of Shoulder and Elbow Surgery. 2021; 29(11): p.2319-25.","DOI":"10.1016\/j.jse.2020.03.003"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Ahmad AA, Sabari SS, Ruslan SR, Abdullah S, Ahmad AR. Wide-Awake Anesthesia for Olecranon Fracture Fixation. Hand (New York, N, Y). 2021;16(3): p.402-6.","DOI":"10.1177\/1558944719861706"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur. 2017; 42(9): p.886-95.","DOI":"10.1177\/1753193417728427"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Frank SG, Lalonde DH. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg. 2012; 20(2):71-3.","DOI":"10.4172\/plastic-surgery.1000744"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Brown M., Bainbridge C., Wong J., Philips A., (2020) WideAwake Surgery Handbook. https:\/\/walant.surgery\/wp-content\/uploads\/2020\/03\/Wide-Awake-Hand-Surgery-Handbook-v2.pdf WALANT website.","DOI":"10.1055\/b-0037-142180"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Wong, N., Yeung, A., Li, K. Y., McGrath, C. P., & Leung, Y. Y. Non-Pharmacological Interventions for Reducing Fear and Anxiety in Patients Undergoing Third Molar Extraction under Local Anesthesia: Systematic Review and Meta- Analysis. International journal of environmental research and public health. 2022; 19(18), 11162.","DOI":"10.3390\/ijerph191811162"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Thakkar M, Bednarz B. Should WALANT surgery be included in the training curriculum? Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020; 73(8): p.1575-92.","DOI":"10.1016\/j.bjps.2020.05.072"},{"key":"ref18","unstructured":"Fish MJ, Bamberger HB. Wide-awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery. [Updated 2022 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK570646\/"}],"container-title":["Acta Orthopaedica Belgica"],"original-title":[],"deposited":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T20:56:46Z","timestamp":1699390606000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.actaorthopaedica.be\/archive\/volume-89\/issue-3\/original-studies\/wide-awake-local-anesthesia-and-no-tourniquet-walant-in-upper-limb-fractures\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,11]]},"published-print":{"date-parts":[[2023,9]]}},"URL":"https:\/\/doi.org\/10.52628\/89.3.11357","relation":{},"ISSN":["0001-6462"],"issn-type":[{"value":"0001-6462","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}