Evaluation of the applicability of the LANT (Local Anesthesia No Tourniquet) technique in the osteosynthesis of distal radius fractures (DRF)

Abstract

To evaluate the applicability of the LANT (Local Anesthesia No Tourniquet) technique in the osteosynthesis of distal radius fractures (DRF), a randomized clinical trial was designed that compared the short-term results between patients treated with local anesthesia without ischemia (LANT) and those operated on with locoregional anesthesia (RA) and ischemia cuff. The main variables of the study were pain, swelling, and patient satisfaction. Bleeding from the surgical wound, mobility, technical difficulty perceived by the surgeon, anesthetic insufficiency, and complications were also analyzed.

Between December 2020 and 2021, 27 patients were included. Those treated with LANT had less pain between days 10 and 15 after surgery, as well as less bleeding during the immediate postoperative period. 22 of the 27 patients in the study required sedation, and 67% of the LANT group needed additional doses of local anesthesia. We conclude that LANT is a viable technique for DRF osteosynthesis and may offer certain benefits by avoiding the use of the ischemia cuff in selected cases. However, the authors of the study recommend adding local anesthesia around the distal radioulnar joint (DRUJ) to improve pain management during reduction maneuvers and emphasize that collaboration with an anesthesiologist was essential during their study.

Level of evidence 1/Therapeutic II.

Keywords

distal radius fractures - Wide Awake Local Anesthesia No Tourniquet (WALANT) - tourniquet - locoregional anesthesia - osteosynthesis

Informed Consent

Written informed consent was obtained from all subjects before the study.

Ethical Approval

Ethical approval for this study was obtained from ethics committee of our hospital “Comitè Ètic d'Investigació Clínica (CEIC) of Hospital Universitari Arnau de Vilanova de la Gerència Territorial Lleida – GSS (CEIC-2360), ensuring this study accomplishes the basic requirements needed for the Spanish law of 3rd July 14/2007 and the Biomedical Research Royal Decree-Law 18th November 1716/201 to be applied.

Trial Registration

ClinicalTrials.gov ID: NCT05421000.

Author's contribution

All of the contributors listed above have made a substantial contribution to the concept or resolved, the article; or the acquisition, analysis, or interpretation of data for the article; wrote the article or critically reviewed it for important intellectual content; approved the version to be published and agreed to be responsible for all aspects of the work to ensure that questions related to accuracy or the integrity of any part of the work are properly investigated and resolved., as stated in the Authorship Declaration Form.

Publication History

Received: 03 February 2024

Accepted: 06 September 2024

Article published online:
23 December 2024

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