Outcomes of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Ankle Fracture Repair: A Systematic Review

Research Type: Level 5 - Case report, Expert opinion, Personal observation Introduction/Purpose: The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique has gained popularity in orthopedic surgery due to its potential to eliminate the risks associated with general anesthesia, reduce intraoperative blood loss, and allow for real-time patient feedback. While it has been widely used in hand and upper extremity procedures, its application in ankle fracture remains limited. This systematic review evaluates the outcomes associated with WALANT in ankle fracture repair. Methods: A systematic search was conducted across PubMed, EMBASE, Scopus, Web of Science and Cochrane databases to identify studies reporting data on ankle fracture repair 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: Three studies met the eligibility criteria, comprising a total of 54 patients undergoing WALANT-assisted ORIF for ankle fractures. Among these, 27 patients had medial malleolus fractures, 19 had lateral malleolus fractures, 5 had bimalleolar fractures, and 3 had trimalleolar fractures. The mean patient age was 59.5 years, with 34 males and 20 females. The mean surgical time was 53 minutes, and the mean intraoperative blood loss was 10.1 ml. The average hospital stay was 22.5 hours. Pain scores measured on the Visual Analog Scale (VAS) demonstrated a mean preoperative score of 4.6, decreasing to 2.6 during local anesthetic injection, 1.2 intraoperatively, and 0.5 postoperatively. Additionally, the mean intraoperative anxiety-related VAS (VAS-A) score was 1.15. No postoperative complications were reported. Conclusion: The findings suggest that WALANT is a safe and effective alternative to traditional anesthesia for ankle fracture repair, offering adequate intraoperative analgesia, minimal blood loss, and a reduced length of hospitalization. However, given the limited sample size and the observational nature of the included studies, further research is necessary to validate these results and establish comparative outcomes with conventional anesthetic techniques.