ArticleHandchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V...2026
Late-Onset Digital Ischaemia after WALANT: Successful Reversal with Off-Label Urapidil.
Article in Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V..., 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: WALANT (Wide Awake Local Anaesthesia No Tourniquet) has revolutionised hand surgery by enabling procedures with a combination of lidocaine and epinephrine, thereby eliminating the need for sedation or a tourniquet. Although epinephrine is now considered safe in low concentrations, rare ischaemic complications may still occur. Case Report: This report concerns a 74-year-old woman who developed delayed-onset digital ischaemia after WALANT-assisted excision of a Dupuytren's nodule. Phentolamine, the standard reversal agent, was unavailable. Local infiltration with urapidil (12.5 mg), a selective α₁-adrenergic antagonist, rapidly restored perfusion and sensation. The patient recovered fully without sequelae. Conclusion: This case highlights a rare but critical complication of WALANT. Urapidil may represent a safe and effective alternative to phentolamine in the management of epinephrine-induced vasospasm.
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