A Comparative Study of Peripheral Nerve Block (PNB Versus Wide Awake Local Anesthesia No Torniquet (WALANTt) In Patients with Hand and Wrist Fracture Requiring Bony Fixation: Clinical Outcome and Patients Satisfaction

Background: Cost-effective, practical and non-aerosol generating procedures are preferred in the operating room including upper extremity bone fixation surgeries. Wide Awake Local Anesthesia No Tourniquet (WALANT) and Peripheral Nerve Block (PNB) are alternative anesthetic techniques used instead of General Anesthesia. This study will compare WALANT and PNB in patients with hand and wrist fractures requiring bony fixation Objectives: To determine if WALANT is superior to PNB in terms of the following outcomes: (1) post-operative pain, (2) length of stay in the Post-Anesthesia Care Unit, (3) days of hospitalization, (4) patient satisfaction, and (5) complications. 

Methodology: A randomized controlled trial design is utilized to compare WALANT and PNB in patients with hand and wrist fractures requiring bony fixation at a military hospital. Collected data analyzed include the patients’ clinical and demographic profile, and the main clinical outcomes of post-operative pain, length of stay, days of hospitalization, patient satisfaction, and presence of complications.

Results: The study was able to get results from 20 patients, who were equally randomized to the

PNB and WALANT methods. For the clinical characteristics, it was noted that besides the length

of hospital stay (which did not show any statistically significant difference), all the other parameters including the PACU time and all the postoperative VAS scores showed significant differences when compared between the two anesthetic techniques. Majority from WALANT group had shorter PACU time. VAS scores in the WLANT group taken at 8 hours, 24 hours and

48 hours post operatively showed lower scores compared to PNB. All the clinical parameters of

those randomized to the PNB group were significantly higher as compared to those in the WALANT group. From the parameters mentioned in the SF-12 Health Survey, it clearly indicated that the anesthetic techniques resulted in good patient satisfaction outcomes. However, in the

comparison of PNB and WALANT, the latter indicated the better outcomes as compared to the

former. WALANT produced better answers from its patients in all the dimensions asked by the

SF-12. Both anesthetic technique had one conversion to General anesthesia.

Conclusion: WALANT provides less post-operative pain, lesser length of PACU stay, and delivering better patient satisfaction, as measured by the data generated from the study population

compared to PNB. There were no differences in terms of hospital stay and complications between

the two techniques.