O3260: Wide-awake Local Anesthesia No Tourniquet (WALANT) within the Pediatric and Adolescent Populations: A systematic review

Background: Wide-awake Local Anesthesia No Tourniquet (WALANT) is an operative technique that utilizes local anesthetic and hemostatic agents to conduct surgical procedures without general anesthesia or use of a tourniquet. This technique is well described and utilized within the adult population with favorable outcomes. However, there is a paucity of literature surrounding the utilization and subsequent outcomes of the WALANT technique within the pediatric population. Therefore, the purpose of this study was to investigate the efficacy and subsequent outcomes of pediatric and adolescent patients who underwent operative management of upper extremity conditions with the WALANT technique.

Methods: A systematic and comprehensive review of the literature was conducted to analyze studies that investigated the WALANT technique within the pediatric and adolescent populations (0-18 years). The study protocol was registered with Prospero and followed the PRISMA guidelines. 315 total studies were identified. After removing duplicates, 174 studies remained and were screened. 4 studies met our inclusion criteria, and their results are compiled within this systematic review. Simple statistics were performed. Means and frequencies are reported.

Results: 127 unique pediatric and adolescent patients who underwent 136 upper extremity procedures were identified. 81 (59.6%) procedures utilized the WALANT technique, while 55 (40.4%) procedures utilized traditional anesthesia (TA). The average age of patients who underwent WALANT was 13.6 years (Range: 7-18 years) compared to 13.7 years (Range: 10-18 years) among patients who underwent TA. Procedures that utilized the WALANT technique included open reduction and internal fixation of a fracture (n=21), tendon repair (n=16), foreign body/k-wire/implant removal (n=10), cyst/hemangioma excision (n=8), tenolysis (n=7), trigger finger release (6), pulley reconstruction (n=5), tendon transfer (n=3), scar revision (n=2), cubital tunnel release (n=1), digital nerve and artery repair (n=1), and irrigation and debridement (n=1). Of the 81 WALANT procedures, only one 13-year-old female patient converted from WALANT to TA. Of the 56 procedures with operative times, the WALANT in room to procedure start, procedure end to out of room, overall room time, and length of stay were all significantly shorter than the TA times. There was no significant difference between operative time between groups. No post-operative complications were reported.

Conclusion: WALANT can safely be performed on pediatric and adolescent patients above the age of 7 years with successful results. Only one patient (1.2%) required conversion to TA after initially consenting to WALANT. Hand and upper extremity surgeons should remain selective with potential younger WALANT candidates to ensure their comfort and compliance throughout the procedure.