Patient Satisfaction and Perioperative Outcomes of Wide-Awake Local Anesthesia No Tourniquet Versus Supraclavicular Peripheral Nerve Block in Elective Hand and Forearm Surgery: A Prospective Comparative Study.

Background/

Objectives

Wide Awake Local Anesthesia No Tourniquet (WALANT) and ultrasound-guided peripheral nerve blocks (PNBs) are increasingly used alternatives to general anesthesia for hand and forearm surgery. While WALANT is commonly perceived as a time-efficient and resource-sparing technique, comparative data regarding patient satisfaction, perioperative pain, and time-related outcomes remain inconsistent. This study aimed to compare WALANT and ultrasound-guided supraclavicular peripheral nerve block techniques with respect to patient satisfaction, perioperative pain, time-related parameters, and surgeon-related outcomes in elective hand and forearm extremity surgery.

Methods

This prospective comparative observational study included 80 adult patients undergoing elective hand or forearm surgery. Patients received either WALANT or ultrasound-guided supraclavicular brachial plexus block according to patient preference. The primary outcome was overall patient satisfaction assessed within 24 h postoperatively. Secondary outcomes included block performance time, waiting time, total anesthesia-related time, intraoperative and postoperative pain scores, additional sedation requirements, postoperative numbness, willingness to choose the same anesthetic technique again, safety outcomes and surgeon satisfaction.

Results

Overall patient satisfaction was significantly higher in the peripheral nerve block group compared with the WALANT group (median [IQR]: 90 [85-100] vs. 80 [70-90], p < 0.0001). Intraoperative and postoperative pain scores were also significantly lower in the peripheral nerve block group. Although block performance time was longer with the peripheral nerve block, waiting time and total anesthesia-related time were significantly shorter compared with WALANT. Surgeon satisfaction and the need for additional intraoperative sedation did not differ significantly between groups.

Conclusions

In elective hand and forearm surgery, ultrasound-guided supraclavicular peripheral nerve block was associated with higher patient satisfaction, lower pain scores, and shorter total anesthesia-related time compared with WALANT. Surgical satisfaction scores were similar with both anesthetic techniques. Considering the heterogeneity of clinical settings and procedural requirements, as well as cost and resource utilization considerations, anesthetic technique selection should be individualized.