Plate osteosynthesis of phalanx fractures using wide-awake local anesthesia no tourniquet technique - cost-effective and associated with less postoperative pain

Sep 29, 2026

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Wide-awake local anesthesia no tourniquet (WALANT), based on local infiltration of lidocaine and epinephrine, is increasingly used in hand and wrist surgery, yet its cost–benefit for phalanx fracture plate fixation remains under-studied. This retrospective study compared general anesthesia with a tourniquet, local anesthesia with a tourniquet, and WALANT regarding anesthesia/operative time, postoperative pain, and vomiting. Among 62 single-phalanx fracture patients, WALANT reduced pain on postoperative day 1 and was cost-effective versus general anesthesia.

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Abstract

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Introduction

J Chin MedAssoc Original article Plate osteosynthesis of phalanx fractures using wide-awake local anesthesia no tourniquet technique is cost-effective and associated with less postoperative pain Wei-Chieh Chena, Chun-Yu Chena,b,c,*, Yen-Chang Lina aDepartment of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; bDepartment of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC; cDepartment of Orthopaedic Surgery, National Defense Medical Center, Taipei, Taiwan, ROC Abstract Background: The wide-awake local anesthesia no tourniquet (WALANT) technique, which is based on the local infiltration of lidocaine and epinephrine, is widely used in hand and wrist surgery. However, few studies have been conducted on the cost–benefit analysis of phalanx fracture surgery using the WALANT technique. This study aimed to investigate the clinical condition, as well as the time spent for anesthesia and operation. We also performed an economic analysis to compare general anesthesia, local anesthesia with a tourniquet, and the WALANT technique for plate fixation of phalanx fractures. Methods: This retrospective study included all patients with single phalanx fractures who underwent open reduction internal fixation with plating between January 2015 and December 2019. Patients were divided into three groups according to the anesthesia method: general anesthesia with a tourniquet (GA group), local anesthesia with a tourniquet (LA group), and the WALANT technique (WALANT group) . Data, including demographics, anesthesia and surgical time, postoperative pain score, and vomiting ratio, were collected and analyzed. Results: A total of 62 patients were included in this study. Of the 62 patients, 15 were included in the GA group, 32 in the LA group, and 15 in the WALANT group. No complications were reported during surgery or follow-up in any group. The GA group exhibited a significantly longer anesthesia time than the other two groups, with an average of 32.4 minutes. However, no significant difference in surgical time was observed among the three groups. The WALANT group exhibited a significantly lower postoperative day 1 pain score than the other two groups. The additional cost of general anesthesia was approximately 350 US dollars (USD), accounting for approximately one-third to one-fourth of the total expenses for phalanx surgery. Conclusion: Open reduction with plate fixation of phalanx fractures using the WALANT technique or local anesthesia was costeffective compared with general anesthesia. Patients who underwent phalanx fracture surgery using the WALANT technique experienced less pain on the first postoperative day because of the adequate tumescent technique and not using a tourniquet during surgery. Keywords: Cost–benefit analysis; Lidocaine; Local anesthesia; Retrospective study; Tourniquet 1. INTRODUCTION Patients undergoing hand fracture surgeries usually receive general anesthesia (GA) or local anesthesia (LA) plus a tourniquet. However, growing interest in wide-awake hand surgery, also referred to as wide-awake local anesthesia no tourniquet (WALANT) technique, has been noted. This technique was first introduced by Donald et al in 2005 and has been recently widely *Address correspondence. Dr. Chun-Yu Chen, Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan, ROC. E-mail address: [iergy2000@gmail.com](iergy2000@gmail.com) (C.-Y. Chen). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2025) 88: 80-84. Received August 16, 2023; accepted November 22, 2023. doi: 10. 1097/JCMA.0000000000001174 Copyright © 2024, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](htt

FAQs

What clinical question does the study address about WALANT for phalanx fractures?

The study evaluates the clinical condition and the time required for anesthesia and operation, and performs an economic comparison between general anesthesia, local anesthesia with a tourniquet, and the WALANT technique for plate fixation of phalanx fractures.

How were patients grouped in this retrospective study?

Patients with single phalanx fractures treated with open reduction internal fixation using plating (Jan 2015–Dec 2019) were divided into three groups based on anesthesia method: GA with a tourniquet, LA with a tourniquet, and WALANT.

What were the main findings regarding pain and costs?

The WALANT group showed a significantly lower postoperative day 1 pain score than the other groups. General anesthesia incurred additional costs of about 350 USD, and WALANT or local anesthesia with tourniquet was described as cost-effective compared with general anesthesia.

Sep 29, 2026

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