Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety
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 id...
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| Format: | Article |
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AOSIS
2025-06-01
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| Series: | Journal of the Colleges of Medicine of South Africa |
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| Online Access: | https://jcmsa.org.za/index.php/jcmsa/article/view/184 |
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| author | Reshlan Govender Antoine G.L. Rocher Mario T. Rankin Khangelani Sondovana Simphiwe C. Phenyane Megan O'Connor |
| author_facet | Reshlan Govender Antoine G.L. Rocher Mario T. Rankin Khangelani Sondovana Simphiwe C. Phenyane Megan O'Connor |
| author_sort | Reshlan Govender |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-1a58ac41e62c4dbaba2fbc06ad704098 |
| institution | Kabale University |
| issn | 2960-110X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Journal of the Colleges of Medicine of South Africa |
| spelling | doaj-art-1a58ac41e62c4dbaba2fbc06ad7040982025-08-20T03:31:23ZengAOSISJournal of the Colleges of Medicine of South Africa2960-110X2025-06-0131e1e610.4102/jcmsa.v3i1.18467Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxietyReshlan Govender0Antoine G.L. Rocher1Mario T. Rankin2Khangelani Sondovana3Simphiwe C. Phenyane4Megan O'Connor5Department of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, DurbanDepartment of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, DurbanDepartment of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, DurbanDepartment of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, DurbanSchool of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, DurbanDepartment of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, DurbanBackground: 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.https://jcmsa.org.za/index.php/jcmsa/article/view/184walantpatient experiencevasanxietyupper limb surgeryoutpatient surgeryorthopaedic surgeryhand surgery. |
| spellingShingle | Reshlan Govender Antoine G.L. Rocher Mario T. Rankin Khangelani Sondovana Simphiwe C. Phenyane Megan O'Connor Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety Journal of the Colleges of Medicine of South Africa walant patient experience vas anxiety upper limb surgery outpatient surgery orthopaedic surgery hand surgery. |
| title | Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety |
| title_full | Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety |
| title_fullStr | Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety |
| title_full_unstemmed | Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety |
| title_short | Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety |
| title_sort | patient experiences of walant for outpatient upper limb surgery a cross sectional study of perioperative pain and anxiety |
| topic | walant patient experience vas anxiety upper limb surgery outpatient surgery orthopaedic surgery hand surgery. |
| url | https://jcmsa.org.za/index.php/jcmsa/article/view/184 |
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