Wide-awake local anesthesia no tourniquet (WALANT) technique versus general anesthesia for the removal of implants after ankle fracture union - A randomized controlled trial.

Ankle fractures which commonly require surgical intervention, often lead to subsequent implant removal, which traditionally involves general or regional anesthesia. This study evaluates the efficacy and safety of the Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique as an alternative to general anesthesia (GA) for ankle implant removal. This single-center, prospective randomized controlled trial at a tertiary orthopedic center was conducted from June 2022 to August 2024. The study included adults over 18 years who required implant removal after a united ankle fracture. Participants were randomly assigned to either the WALANT or the GA group. Out of 78 screened participants, 56 were included in the final analysis. The WALANT group showed significantly lower pain scores at 2 and 6 hours postoperatively and reduced postoperative anxiety levels compared to the GA group. Operating room times were comparable between the groups. The WALANT technique was well-tolerated, with minimal adverse effects, and was particularly effective in reducing postoperative nausea and recovery room time compared to general anesthesia. The WALANT technique for ankle implant removal is a safe and effective alternative to general anesthesia, offering benefits such as less postoperative pain, anxiety, and nausea, along with shorter recovery times. However, its success depends on careful patient selection and the surgeon's experience with the technique. This study demonstrates WALANT's potential for broader application in lower extremity surgeries, suggesting a viable option for enhancing patient outcomes and operational efficiency in orthopedic practice.