Comparison between Functional Outcomes of Flexor Tendon Repair Under Wide-Awake Local Anaesthesia No Tourniquet and Brachial Plexus Block

Haredy, Mostafa Mamdoh; Mazeed, Ahmed Salah Ahmed; Hussein, Omar Muhhamed; Abde El Megeed, Ahmed Gaber

doi:10.21608/ejprs.2025.456997

Comparison between Functional Outcomes of Flexor Tendon Repair Under Wide-Awake Local Anaesthesia No Tourniquet and Brachial Plexus Block

Document Type : Original Article

Authors

The Department of Plastic Surgery, Faculty of Medicine, Sohag University

10.21608/ejprs.2025.456997

Abstract

Background: Flexor tendon injuries have long been a significant
challenge in hand surgery, with an incidence of approximately
4.83 per 100,000 people. However, debates persist
regarding the optimal repair techniques and rehabilitation
approaches.
Objective: This study aims to gather additional data on the
functional outcomes of flexor tendon repair performed under
Wide-Awake Local Anesthesia No Tourniquet (WALANT)
compared to Brachial Plexus Block (BPB).
Patients and Methods: All patients who underwent a primary
flexor tendon repair had a tendon injury in zone I or II.
A total of 30 flexor tendon repairs were done which meet the
inclusion criteria. Simple randomization was used that odd
numbered patients were operated with WALANT and even
numbered patients with BPB.
Results: A total of thirty flexor tendon repairs in zone I or
II were included in the final evaluation. This group comprised
20 males and 10 females, with an average age of 28 years (SD:
8) and a mean follow-up of 6 months. Age was insignificantly
different between the two groups. There was significantly
higher mean operative time in group II (BPB) compared to
group I (WALANT) (p = <.001). The Pain of Procedure by the
mean VAS score was insignificantly different between the two
studied groups (p = 0.5) There were insignificant differences
between the two studied groups as regard the mean DASH
score (p = 0.1).
Conclusions: The Wide-Awake Local Anesthesia No
Tourniquet (WALANT) technique is an effective approach for
flexor tendon repair in Zone II, yielding comparable functional
outcomes and complication rates to Brachial Plexus Block
(BPB). Additionally, WALANT offers significant benefits,
including shorter operative time, fewer anesthesia-related delays,
and reduced postoperative pain, leading to decreased analgesic
use.

Keywords

References

1- Gelberman R.H., Manske P.R., Akeson W.H., Woo S.L.Y.,
Lundborg G. and Amiel D.: Flexor tendon repair. J. Orthop.
Res., 4 (1): 119-28, 1986.
2- Bamal R., Alnobani O., Bastouros E., Nolan G., Morris E.,
Griffiths S., et al.: Wide-awake local anesthesia no tourniquet
(WALANT) for flexor tendon repairs as change in
practice during the COVID-19 pandemic: A retrospective
cohort study with outcomes. Cureus, 15 (3), 2023.
3- Elhameed M.A.A., Hassan K.M., Metawally A.M.A. and
Sabry M.: The outcome of the WALANT technique in primary
hand flexor tendons repair. JPRAS Open, 40: 77-84,
2024.
4- Abd Elhameed M.A., Hassan K.M., Metawally A.M.A.
and Sabry M.: The outcome of the WALANT technique
in primary hand flexor tendons repair. JPRAS Open, 40:
77-84, 2024.
5- Lee S.K., Kim S.G. and Choy W.S.: A randomized controlled
trial of minor hand surgeries comparing wide
awake local anesthesia no tourniquet and local anesthesia
with tourniquet. Orthop. Traumatol. Surg. Res., 106 (8):
1645-51, 2020.
6- Townsend C.B., Henry T.W., Matzon J.L., Seigerman D.,
Sodha S.C. and Beredjiklian P.K.: Functional outcomes of
flexor tendon repair in the fingers: A comparison of wideawake
local anesthesia no tourniquet versus traditional anesthesia.
Hand, 18 (4): 635-40, 2023.
7- HIGGINS A., LALONDE D.H., BELL M., MCKEE D.
and LALONDE J.F.: Avoiding flexor tendon repair rupture
with intraoperative total active movement examination.
Plast. Reconstr. Surg., 126 (3): 941-5, 2010.
8- Starnes T., Saunders R.J. and Means K.R. Jr.: Clinical
outcomes of zone II flexor tendon repair depending on
mechanism of injury. J. Hand Surg. Am., 37 (12): 2532-
40, 2012.
9- Pan Z., Qin J., Zhou X. and Chen J.: Robust thumb flexor
tendon repairs with a six-strand M-Tang method, pulley
venting, and early active motion. J. Hand Surg. Eur., Vol.
42 (9): 909-14, 2017