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Background and Aims Regional anesthesia has been used for hand surgeries for many years, but a recent technique has been becoming increasingly popular: the ‘wide- awake local anesthesia no tourniquet’ (WALANT). This allows the combination of sensitive block and a bloodless field, with preservation of motor function.
Methods We selected a 63-year-old male patient with an old traumatic tendon section in the first finger of his hand that resulted in loss of mobility. One year later, he was proposed for tendon transposition from the second to the first finger to reestablish total abduction ability. The patient only had grade 1 obesity. We performed ultrasound guided peripheral nerve blocks of the radial, ulnar and median nerves at the forearm level, which preserved motor function during the surgery and guaranteed loss of pain sensation. To obtain a bloodless field without a tourniquet, we performed ultrasound assisted subcutaneous infiltration of lignocaine and epinephrine on the dorsal surface of the hand.
Results The surgery lasted two hours, and the size of the transposed tendon was deemed appropriate through intraoperative observation of ideal hand mobility (see QR code). The orthopedics team confirmed optimal surgical field conditions with this technique. The patient was evaluated at 1 month and, with physical therapy, regained almost all mobility of the hand and showed immense satisfaction.
Conclusions For hand procedures where there’s an advantage in evaluating motor function throughout the surgery, the WALANT technique proved itself to be an excellent anesthetic choice. Therefore, this technique should be considered more frequently when these surgeries take place.
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