ReviewPlastic and reconstructive surgery. Global open2021
How to Minimize the Pain of Local Anesthetic Injection for Wide Awake Surgery.
Review in Plastic and reconstructive surgery. Global open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed.
- Trial
- Ultrasound-guided injection treatments for tendinopathy: an update.Skeletal radiology · 2026Review
- Augmentation Mammoplasty Under Tumescent Local Anesthesia: A Multicenter Retrospective Analysis of 1644 Consecutive Cases-Safety and Efficacy in Subglandular and Submuscular Approaches.Journal of clinical medicine · 2026Article
- A systematic review of the Wide Awake Local Anesthesia no Tourniquet (WALANT) approach in pediatric hand surgery.JPRAS open · 2026Review
- Wide Awake Facial Reconstruction: A Literature Review, Cost Analysis, and Practical Guide.Plastic and reconstructive surgery. Global open · 2026Article
- Surgeons Can Decrease the Pain of WALANT Local Anesthesia Injection if They Ask for Patient Feedback.Plastic surgery (Oakville, Ont.) · 2026Article
- Enhancing Compliance Through Local Anesthesia in Extended-Release Buprenorphine Therapy: A Report of Two Cases.Cureus · 2026Article
- Article
- Companian Editorial Letter.Journal of hand and microsurgery · 2026Article
- Managing complex hand, wrist, and forearm injuries with WALANT: A case-based technical report.Journal of hand and microsurgery · 2025Article
- A Practical Guide to Local Anesthetic Options for Wide-awake Hand Surgery (WALANT): A Laboratory-based Experimental Study.Plastic and reconstructive surgery. Global open · 2025Article
- State-of-the-art review: The advantage and use of Wide Awake Local Anaesthesia No Tourniquet (WALANT) for nerve decompression surgery.International orthopaedics · 2025Review
- Patients Tracking Pain Episodes Show Wide-awake Local Anesthesia Without Tourniquet Can Be Nearly Painless.Plastic and reconstructive surgery. Global open · 2025Article
- How to Start WALANT Procedure Room Surgery Like Ghana to Improve Access and Affordability.Plastic and reconstructive surgery. Global open · 2025Article
- Minimal Pain Tumescent Local Anesthesia for Wide-awake Forehead Flap Nasal Reconstruction.Plastic and reconstructive surgery. Global open · 2025Article
- Wide-awake Local Anesthesia No Tourniquet Tendon Transfers in a Patient With High Median Nerve Palsy.Plastic and reconstructive surgery. Global open · 2025Article
- Wide Awake Breast Reduction.Plastic and reconstructive surgery. Global open · 2025Article
- Minimally Painful Tumescent Local Anesthesia for Wide-awake Javid Loop Colostomy Reversal.Plastic and reconstructive surgery. Global open · 2025Article
- Minimal Pain Tumescent Local Anesthesia WALANT Basal Thumb Arthritis Implant Arthroplasty.Plastic and reconstructive surgery. Global open · 2025Article
- Words to Avoid During Wide-awake Local Anesthesia No Tourniquet Surgery to Enhance Patient Experience.Plastic and reconstructive surgery. Global open · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
After reading this article, the participant should be able to (1) almost painlessly inject tumescent local anesthesia to anesthetize small or large parts of the body, (2) improve surgical safety by eliminating the need for unnecessary sedation in patients with multiple medical comorbidities, and (3) convert many limb and face operations to wide awake surgery. We recommend the following 13 tips to minimize the pain of local anesthesia injection: (1) buffer local anesthetic with sodium bicarbonate; (2) use smaller 27- or 30-gauge needles; (3) immobilize the syringe with two hands and have your thumb ready on the plunger before inserting the needle; (4) use more than one type of sensory noise when inserting needles into the skin; (5) try to insert the needle at 90 degrees; (6) do not inject in the dermis, but in the fat just below it; (7) inject at least 2 ml slowly just under the dermis before moving the needle at all and inject all local anesthetic slowly when you start to advance the needle; (8) never advance sharp needle tips anywhere that is not yet numb; (9) always inject from proximal to distal relative to nerves; (10) use blunt-tipped cannulas when tumescing large areas; (11) only reinsert needles into skin that is already numb when injecting large areas; (12) always ask patients to tell you every time they feel pain during the whole injection process so that you can score yourself and improve with each injection; (13) always inject too much volume instead of not enough volume to eliminate surgery pain and the need for "top ups."
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.