Wide-awake local anesthesia for flexor tendon repair yielded positive functional outcomes

CHICAGO — According to presented results, flexor tendon repair with a wide-awake local anesthesia no tourniquet technique offers comparable functional benefits vs. traditional anesthesia.

“Flexor tendon lacerations in the fingers can be challenging injuries to treat,” Clay Townsend, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “Traditionally, these are performed under a traditional anesthesia method, such a general anesthesia or [medication-assisted treatment]. Recently, wide-awake local anesthesia no tourniquet surgery has gained increasing popularity and use for these repairs,” he added.

Clay Townsend

Townsend and colleagues at Rothman Orthopaedic Institute analyzed 65 primary flexor tendon repairs in zones 1 and 2 without tendon graft for closed avulsions or open lacerations. According to the abstract, 23 flexor tendon repairs were performed with a wide-awake local anesthesia no tourniquet (WALANT) technique and 42 flexor tendon repairs were performed with traditional anesthesia (TA).

Outcome measures included quick DASH (qDASH) scores, VAS pain scores, grip strength, range of motion (ROM), infection, tendon rupture, stiffness requiring reoperation and complex regional pain syndrome.

The WALANT group reported an overall complication rate of 34.8% (n = 8) and a reoperation rate of 26.1% (n = 6), while the TA group reported an overall complication rate of 11.9% (n = 5) and a reoperation rate of 7.1% (n = 3). Final qDASH score was 17.2 in the WALANT group and 23.3 in the TA group. At final follow-up, Townsend and colleagues found no statistical differences between the groups in rupture rates, ROM, grip strength or VAS pain scores.

“This is one of the first studies that has published the outcomes of flexor tendon repairs performed under wide-awake surgery and the first comparative study that we could identify,” Townsend said. “These results can be helpful for both surgeons and patients in establishing expectations,” he added.

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American Academy of Orthopaedic Surgeons Annual Meeting