Comparison of Anesthesia Results between Wide Awake Local Anesthesia no Tourniquet (WALANT) and Forearm Tourniquet Bier Block in Hand Surgeries: A Randomized Clinical Trial

Document Type : RESEARCH PAPER


1 Department of Orthopedy, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran

2 Department of Anesthesiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran

3 Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran


Background: There is still some debate regarding the most proper anesthetic technique in minor hand surgeries. We
hypothesized that both the WALANT and forearm tourniquet Bier block methods provide effective anesthesia in minor
hand surgeries without significant difference.
Methods: A total of 85 patients consented to participate in this study and were randomized into WALANT and single
tourniquet forearm Bier block groups. In WALANT group, patients received adrenaline-contained lidocaine without
tourniquet while lidocaine was administered accordingly after applying a forearm tourniquet in Bier group. Due to
difference in intervention methods, the study was non-blinded. Need for additional analgesia during surgery, visual
analogue scale (VAS) for pain intensity during operation and an hour later, amount of bleeding and active hand
movements were evaluated and recorded.
Results: The need for analgesia and severity of pain (VAS) during surgery and one hour later were significantly less
in WALANT group, whereas the amount of bleeding was less in Bier block group. The ability to move hand and fingers
during the operation was the same in both groups.
Conclusion: Both WALANT and single cuff forearm tourniquet Bier block are effective methods in minor hand surgeries,
however, forearm Bier block provides less analgesia and pain control with a drier field than WALANT method.
Level of evidence: I