Comparison of the wide-awake local anesthesia with no tourniquet (WALANT) technique with local anesthesia in chest tube placement procedures
Özet
Aim: Wide-awake local anesthesia with no tourniquet (WALANT) is increasingly
used in surgical practice due to its safety profile, reduced resource requirements,
and elimination of sedation. Although widely studied in hand surgery, its role in
emergency thoracic procedures remains unclear. This study aimed to compare the
efficacy of WALANT and lidocaine-based local anesthesia in patients undergoing
emergency tube thoracostomy, focusing on pain perception, bleeding-related
complications, and clinical outcomes.
Materials and Methods: This prospective, single-blind, controlled study was
conducted between November 1, 2023, and August 1, 2024, in the emergency
medicine and thoracic surgery clinics of a tertiary care hospital. Sixty-six adult
patients requiring chest tube placement were included and randomized based on
medical record number parity into two groups: WALANT (n = 33) and lidocaine
local anesthesia (n = 33). The WALANT solution consisted of lidocaine, isotonic
saline, sodium bicarbonate, and epinephrine. Pain was assessed using the Visual
Analog Scale (VAS) before and five minutes after the procedure. Bleeding-related
complications and demographic variables were recorded. Statistical significance
was set at p < 0.05.
Results: The mean age of participants was 46 ± 20 years; 78.8% were male.
Indications included spontaneous pneumothorax (37.9%), traumatic pneumothorax
(22.7%), malignant effusion (21.2%), hemothorax (10.6%), and empyema (7.6%).
A statistically significant reduction in VAS scores was observed when comparing
pre- and post-procedural pain between groups (p = 0.004). WALANT demonstrated
significant pain reduction particularly in patients with traumatic pneumothorax (p =
0.01). No severe bleeding complications were observed in either group, including
patients receiving anticoagulant or antiplatelet therapy.
Conclusion: WALANT appears to be a safe and effective alternative to lidocainebased local anesthesia for emergency tube thoracostomy. It provides significant
analgesic benefit without increasing bleeding-related complications and may be
particularly advantageous in trauma-related thoracic injuries. Further studies
incorporating patient-reported outcomes and long-term follow-up are warranted.
Keywords: Anesthesia, local, tube thoracostomy, local anesthesia, pneumothorax,
emergency medicine, thoracic procedures
Sürdürülebilir Kalkınma Amaçları
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SKA 3: Sağlıklı Bireyler
Atıf için künye
Çalbay, A., Ulaş, A. B., Akgöl Gür, S. T., Çinan, K., Çalbay, M. M., Tunçez, O. E., Bayramoğlu, N., & Kaşali, K. (2026). Comparison of the wide-awake local anesthesia with no tourniquet (WALANT) technique with local anesthesia in chest tube placement procedures. The Atlantic Journal of Medical Science and Research (Online), 2026(6), 301–307. https://doi.org/10.5455/atjmed.2026.03.022
BibTeX
@article{calbay2026-213643,
author = {Çalbay, Ayça and Ulaş, Ali Bilal and Akgöl Gür, Sultan Tuna and Çinan, Kadir and Çalbay, Murat Maksut and Tunçez, Orhan Enes and Bayramoğlu, Nabi and Kaşali, Kamber},
title = {Comparison of the wide-awake local anesthesia with no tourniquet (WALANT) technique with local anesthesia in chest tube placement procedures},
journal = {The Atlantic Journal of Medical Science and Research (Online)},
year = {2026},
volume = {2026},
number = {6},
pages = {301--307},
issn = {2792-0151},
doi = {10.5455/atjmed.2026.03.022},
url = {https://akademik.atauni.edu.tr/yayinlar/213643-comparison-of-the-wide-awake-local-anesthesia-with-no-tourniquet-walant}
}