Wide Awake Surgery Is Safe and Feasible in Pediatric Orthopaedic Surgery

Wide awake local anesthesia no tourniquet (WALANT) techniques are increasingly utilized for hand surgeries in adults, given the clinical benefits to patients, reduced environmental waste during surgery, and lower costs to the health care system. This technique is not widely employed for pediatric hand surgeries given concerns for parental and patient anxiety, noncompliance during surgery, and tolerance of administration of local anesthesia. Select patients undergoing amenable procedures can potentially benefit from this method and enjoy the lower morbidities and costs that adult patients enjoy. It was hypothesized that WALANT technique would be safe, efficient, and feasible in a pediatric cohort. A retrospective chart review of all 223 upper extremity surgeries performed by a single surgeon at a pediatric hospital and its surgery center was performed. Patients aged 7 to 20 years scheduled for local anesthesia without monitored anesthesia care were included. These patients were not instructed to fast before their procedure. Patient demographics, surgical and recovery room times, pain scores, and complications were recorded. Eighty-six patients underwent surgery under local anesthesia and were compared with 76 patients undergoing similar surgeries under general anesthesia. Both soft tissue and bony surgeries were included. The WALANT group had both significantly shorter average length of surgery and time spent in recovery compared with the general anesthesia group, translating into significant cost savings. Lower pain scores and fewer narcotic prescriptions were noted. There were no conversions to any type of monitored anesthesia care, nor cancellations due to inability to tolerate administration of local. No difference in infection rates or other complications were noted between groups. WALANT is safe, efficient, and feasible in a pediatric hospital for a variety of surgeries. Expanding this technique for use in select children allows patients, their families, and the health care system to enjoy the clinical, financial, and environmental benefits of WALANT surgery. Level III-retrospective comparative study.