Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis

Background: To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. Methods: We conducted a comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library from inception to October 2018. All randomized or quasi-randomized trials and cohort studies comparing WALANT procedure versus local anesthesia or intravenous regional anesthesia with tourniquet among atraumatic hand surgeries were included. Methodological quality and risk of bias of eligible studies were assessed by three independent reviewers. The random effects model was used due to both statistical and clinical heterogeneity among studies. Results: The search yielded 496 records, of which 9 studies were included in the systematic review. We were able to pool findings for operative time, post-operative pain scores, patient satisfaction, and complication rates. On the average, the WALANT group had longer operative times by 2.06 minutes (pooled mean difference, random effects, 95% confidence interval 0.46 to 3.67 minutes, p = 0.01, I-2 0%, p = 0.66). The post-operative pain scores were lower in the WALANT group by an average of two VAS points (random effects, pooled mean difference -2.40, 95% confidence interval -3.41 to -1.38, p < 0.00001; I-2 0% p = 0.99). We had insufficient evidence to demonstrate a difference in terms of patient satisfaction (random effects, pooled risk ratio 0.98, 95% confidence interval 0.93 to 1.03, p = 0.36, I-2 0%, p = 0.64) and complication rates (random effects, pooled risk ratio 0.40, 95% confidence interval 0.07 to 2.18, p = 0.29, I-2 60% p = 0.08) between WALANT versus conventional methods. Conclusions: The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates.