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4CPS-145 Collaborative implementation of ‘WALANT’ (local anaesthetic) technique in a hand surgery ward
  1. EE Nagy1,
  2. A Bor1,
  3. N Gyimesi1,
  4. H Kovács2
  1. 1Jenő Manninger Trauma Centre, Department of Pharmacy, Budapest, Hungary
  2. 2Jenő Manninger Trauma centre, Department of Hand Surgery, Budapest, Hungary


Background and Importance The Wide-Awake Local Anaesthesia No Tourniquet (WALANT) technique is an alternative approach in certain hand- and upper extremity surgery procedures, that utilises a combination of local anaesthetic and haemostatic agent to replace traditional general anaesthesia and tourniquet application, making procedures time-saving, cost-effective and also enables faster recovery. To meet these expectations, a request for developing an adapted formulation of WALANT solution arrived from Hand Surgery Department.

Aim and Objectives Our aim was to designate the obtainable and suitable pharmaceutical products serving as the basis of the WALANT solution. Also, we aimed to design a practical and visually comprehensible dosage guide (in table form), as well as to reply to various professional questions that may arise (duration of action, shelf life, side effects, etc.).

Material and Methods An adapted formulation was developed, relying on international recommendations and extensive literature research, considering professional and economic issues, harmonising different measurement units. The dosage guide was compiled in accordance with the instructions provided by SPCs, in two effective concentrations of various commercially available products.

Results The local concentration of haemostatic adrenaline solution was determined to be 0.005% (1:200,000 ratio for adults). For children and cardiology patients, exceeding a 0.0025% (1:400,000) local adrenaline concentration is not recommended; therefore, our dosage table includes the formula of diluted solution as well. As for the local anaesthetic, lidocaine was used in 1% concentration. Chemical stability of the solution was ensured by adding sodium bicarbonate (0.84%). The appropriate amount of normal (0.9%) saline solution was used for dilution, depending on the desired total volume (5, 10 or 20 ml). After ‘in situ’ preparation of WALANT solution by physicians, opened ampules were advised to be discarded, due to concerns of microbiological stability, labelling and storage safety. Hand Surgery Department specialists were educated on potential adverse drug reactions and management. The workload of the anaesthetic team has been considerably reduced by approximately 30–40%, which has had good impact on human resource capacities and cost-effectivity.

Conclusion and Relevance The introduction of WALANT technique has had a beneficial effect on cost-effectivity while maintaining patient safety. This successful collaboration strengthened the professional relationship and trust between the Hand Surgery Department and Hospital Pharmacy.

Conflict of Interest No conflict of interest.

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