• The Korean Journal of Pain
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• v.12 no.1
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• pp.16-20
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• 1999

Background: Tourniquet pain has important impacts on anesthesia. Tourniquet pain and accompanying cardiovascular changes are important factors that make patients in distress during anesthesia. As tourniquet pain may be modified by anesthesia, a study on the changes in the neural functions by tourniquet inflation in normal volunteers is important. Methods: Time-dependent changes in tourniquet pain, heart rate, phantom limb sensation, motor function, pain to pressure on upper extremity of 10 healthy and unpremedied volunteers were measured. Each parameter were measured every 5 minutes starting from 10 minutes before inflation to 15 minutes after deflation of tourniquet. Tourniquet was deflated when the subject felt unbearable pain (score 100 with visual analog scale). Results: Subjects manifested time-dependent pain responses to tourniquet inflation, characterized by increase in VAS, systolic and diastolic blood pressure. Mean duration of tourniquet inflation was 36.4 minutes, volunteers experienced motor paralysis at 27.6 minutes and sensory loss at 33.1 minutes. Pain to pressure decreased over time in both arms. The degree of decrease was greater in the arm on which tourniquet was applied than that in the non-applied arm. Phantom limb sensation occurred in 3 subjects. Conclusions: This study demonstrated dynamic changes in the neural functions during tourniquet inflation period. Tourniquet-induced pain and resultant hypertension occurred in all subjects. Appropriate anesthetic management is needed for the surgery using tourniquet.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.531-537
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• 2022

Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.