WALANT vs. Brachial plexus block with tourniquet in zone 2 flexor tendon repair: An evidence-based comparison.

Background: Zone 2 flexor tendon repair is traditionally performed using brachial plexus block, general anaesthesia, or local anaesthesia with a tourniquet. The Wide-Awake Local Anaesthesia No Tourniquet (WALANT) technique, as the name implies, allows these procedures to be performed under local anaesthesia without a tourniquet. This study aims to evaluate the efficacy of WALANT in zone 2 flexor tendon repair, comparing it to brachial plexus block in terms of local anaesthetic drug requirement, pain management, surgical field visibility, postoperative outcomes, and patient satisfaction. Methodology: A prospective observational study was conducted with 24 patients in each group: one undergoing zone 2 flexor tendon repair under WALANT, and the other with brachial plexus block. The amount of local anaesthetic required, pain scores using the Visual Analog Scale (VAS), surgical field visibility using the Surgical Field Rating (SFR) scale, postoperative hospital stay, complications, and patient preferences were compared between the two groups. Results: The pain score during injection was significantly lower in the WALANT group (2.1 ± 0.3 vs 3.7 ± 0.8) whereas the perioperative and postoperative pain scores where similar in both groups. The average operative time (49.7 min vs. 53.2 min) and surgical field visibility (SFR grade 3-58.3 % vs 45.8 %) were comparable in both groups. The WALANT group had a significantly shorter postoperative hospital stay (18.16 h vs. 34.04 h). No complications were reported in the WALANT group, while one postoperative tendon rupture occurred in the brachial plexus block group. All WALANT patients opted the technique for future procedures, while 16.7 % of brachial plexus block patients did not prefer the same method again. Conclusion: WALANT offers several advantages over brachial plexus block, with similar surgical field visibility, intraoperative and postoperative pain control, without the discomfort of a tourniquet and with the added advantage of intraop testing of repair. It is a safe and effective alternative to brachial plexus block for zone 2 flexor tendon repair.