Background and Aims WALANT (Wide Awake Local Anesthesia No Tourniquet) might be a real alternative to the axillary block (BAX) in hand and wrist ambulatory surgery. Using long-acting local anesthetics, it could prolong postoperative analgesia while preserving motor skills. We hypothesize that WALANT using lidocaine/bupivacaine and dexamethasone prolongs time to first rescue analgesic after surgery compared to BAX using mepivacaine.
Methods In patient scheduled for ambulatory upper limb surgery, WALANT and BAX were compared using a propensity score-matched analysis surgery in terms of time to first rescue analgesic (primary endpoint), total analgesics amount during the first 24 hours after surgery, duration of sensory blockade and maximal pain scores at rest and during movement in PACU, 12 and at 24 hours after surgery.
Results After informed consent, sixty patients were included. After propensity score matching, 20 patients in each group were compared. Time to first rescue analgesic was significantly higher in the WALANT group (24.74 [20.22; 27.86] h) and (10.88 [9.17; 16.18] h, p = 0.02) in the BAX group. Total consumption of acetaminophen during 24h was higher in the BAX group (1.00 [1.00–1.00] g vs 2.50 [1.00–4.50]g, p = 0.03). The duration of sensory blockade was prolonged in the WALANT group (26.43 [22.88; 28.58] h) versus (4.84 [4.20; 5.46] h, p < 0.01). Pain scores at rest and on movement were significantly higher in the BAX group than in the WALANT group at 12 hours and at 24 hours.
Conclusions Compared to BAX, WALANT significantly prolongs effective analgesia in ambulatory upper limb surgery without adverse events.
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