Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. The fracture reduction quality, functional outcomes, and overall patient satisfaction were comparable between patients in the wide-awake local anesthesia with no tourniquet (WALANT) and balanced anesthesia (BA) groups

Evidence Rating Level: 2 (Good)

DRF is a common injury that can require surgical intervention. As elderly patients with comorbidities increasingly opt for surgery to achieve quicker recovery and preserved functionality after injury, more suitable anesthetic options are being explored. WALANT offers various benefits including, cost-effectiveness, improved patient satisfaction, and reduced risks associated with systemic anesthesia. BA, involving multimodal pain management, has gained popularity and lowered the need for gas anesthetics and opioids. This retrospective cohort study aimed to investigate patient characteristics, surgical outcomes, intraoperative pain, anxiety, and satisfaction in patients (n=93) with DRF undergoing plating surgery via BA (n=55) or WALANT (n=38) techniques. In the WALANT group, patients were older (mean age [SD] 63.0 [16.5] vs. 54.4 [16/7], P=0.007) and had fewer intraarticular fractures (p=0.009) compared to the BA group. Surgical time was shorter in the WALANT group (MD, − 19.8 [ − 33.8 to − 5.9]; P < 0.01). Postoperative radiographs indicated similar reduction and plating quality in both groups. 3- and 6-month pronation was worse in the WALANT group (P=0.05; P=0.03), while 12-month flexion was better (P=0.02). Other outcomes, including remaining wrist and forearm range of motion, grip strength, QuickDASH scores, and patient satisfaction, showed no significant differences. These findings demonstrate that the WALANT and BA groups had comparable reduction quality, functional outcomes, and overall satisfaction, suggesting that the WALANT technique could serve as an alternative for DRF plating surgery in specific patient cases.

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