Outcomes of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Hallux Procedures: A Systematic Review

Research Type: Level 5 - Case report, Expert opinion, Personal observation Introduction/Purpose: Wide-Awake Local Anesthesia No Tourniquet (WALANT) has gained popularity in orthopedic surgery due to its ability to avoid the risks associated with general anesthesia, reduce intraoperative blood loss, and provide real-time patient feedback from patients. While the technique is commonly applied in upper extremity procedures, its use in hallux surgeries remains underexplored. This systematic review evaluates the outcomes of WALANT in hallux procedures. Methods: A systematic search was conducted across PubMed, EMBASE, Scopus, Web of Science and Cochrane databases to identify studies that reported outcomes of hallux procedures performed under WALANT anesthesia. The included studies utilized a standardized anesthetic protocol consisting of 2% lidocaine with epinephrine, 8.4% sodium bicarbonate, and saline. Results: Six studies were included, comprising a total of 96 patients (28 males, 68 females), with a mean age of 55.2 years. The most common procedures were hallux valgus correction (51 feet) and first MTP joint fusion (24 feet). The mean surgical time was 37 minutes, and the mean hospital stay was 6.2 hours. Pain scores measured using the Visual Analog Scale (VAS) showed a mean preoperative score of 3.38, which decreased to 1.71 during the injection, 0.58 intraoperatively, and 1.55 postoperatively. The mean VAS-A scores were 2.70 preoperatively, 3.24 during the injection, 1.66 intraoperatively, and 0.85 postoperatively. Conclusion: The findings suggest that WALANT is a safe and effective alternative for hallux procedures, providing adequate intraoperative pain control, a significant reduction in postoperative pain, and minimal hospitalization. The technique offers benefits such as short surgical times and a low complication rate. However, due to the limited number of studies included, further research is necessary to validate these results and compare WALANT with traditional anesthesia methods in hallux surgeries.