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Original Research
Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety
Submitted: 02 February 2025 | Published: 13 June 2025
About the author(s)
Reshlan Govender, Department of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaAntoine G.L. Rocher, Department of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Mario T. Rankin, Department of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Khangelani Sondovana, Department of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Simphiwe C. Phenyane, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Megan O'Connor, Department of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Abstract
Background: Demands on South African operating theatres have led to more outpatient upper limb surgery being performed under wide awake local anaesthesia no tourniquet (WALANT). This study aimed to determine patients’ anxiety and pain related to WALANT use in outpatient upper limb surgery, and to identify factors that increased the risk of heightened pain experiences.
Methods: This multicentre cross-sectional study conducted between December 2022 and June 2024 utilised the ‘strengthening the reporting of observational studies in epidemiology guidelines’. Patients receiving outpatient upper limb surgery under WALANT were prospectively recruited for participation in an investigator-administered questionnaire of 15 questions regarding their demographics, procedure, anxiety and pain experiences. Patients’ anxiety and pain experiences were summarised, and relationships between demographic or procedural factors and anxiety or pain scores were tested.
Results: In all, 85 patients were included. The most frequent procedures performed were tendon repairs and trigger releases (42% and 12% respectively). Of the total recruited patients, 45% reported moderate to severe anxiety perioperatively. The median visual analogue scale (VAS) score for pain of injection and procedure were 20 mm and 0 mm, respectively. Male patients and isiZulu speaking patients had lower VAS pain scores, while very anxious patients had higher VAS pain scores.
Conclusion: Forty-five per cent of patients who underwent outpatient upper limb surgery under WALANT experienced perioperative anxiety. They did not experience the anaesthetic or surgery as painful on average. Pain scores were related to perioperative anxiety. Future investigation should further explore the relationship between perioperative anxiety and pain.
Contribution: Wide awake local anaesthesia no tourniquet is well tolerated in patients undergoing outpatient upper limb surgery.
Keywords
Sustainable Development Goal
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