Patient satisfaction using wide-awake local anaesthesia no tourniquet (WALANT) in adults undergoing elective hand surgery: A systematic review and meta-analysis

Background: Wide-awake local anaesthesia no tourniquet (WALANT) is increasing in popularity within hand surgery. However, evidence is unclear on patient satisfaction rates when WALANT is compared against more traditional anaesthetic techniques where pneumatic tourniquets are used. The present study aimed to evaluate the satisfaction rates of patient with the WALANT technique.

Methods: A literature search was performed using the PubMed, Embase and Cochrane databases for observational studies and randomised controlled trials (RCTs) from 2003 up to June 2023. The review was carried out among adults undergoing elective hand surgery. The mean difference in operation time and standardised mean difference (SMD) for patient satisfaction and post-operative pain (<24 h) were computed using the random effects model. The quality of studies was evaluated using RoB-2 for RCTs and risk of bias in non-randomised studies ROBINS-I for observational studies. Data were collated and a meta-analysis was performed.

Results: Five RCTs and 15 observational studies were included in our analysis, comprising a total cohort of 1800 patients. Among them, 899 patients received WALANT (50.0%). Among the RCTs, patient satisfaction was found to be higher in patients receiving WALANT (SMD 1.01, 95% CI 0.11-1.92, p = 0.03, I² = 93%). Post-operative pain was found to be non-significant using WALANT (95% CI -3.72-0.03, p = 0.10, I² = 99%), as was operative time difference (95% CI -0.42-0.40, p = 0.96, I² = 0%).

Conclusion: The use of WALANT in elective hand surgery potentially results in higher satisfaction rates compared with anaesthesia with tourniquets. Post-operative pain and operation time were also found to be non-inferior in WALANT, but more robust studies are needed to verify these findings.