The effect of wide-awake anesthesia, intravenous regional anesthesia, and infraclavicular brachial plexus block on cost and clinical scores of patients undergoing hand surgery

The aim of our study was to compare the clinical results and costs of wide-awake local anesthesia no tourniquet (WALANT), intravenous regional anesthesia (IVRA), and infraclavicular brachial plexus block (IC-BPB). The patients were divided into WALANT, IVRA, IC-BPB groups, each with 50 patients. Demographic information, induction time, use of sedation, number of patients who were converted to general anesthesia, time in postanesthesia care unit (PACU), amount of bleeding during surgery, presence of tourniquet pain, hand motor function during surgery, time to onset of postanesthesia pain, discharge time, complications, and anesthesia costs were compared. Sedation was given to 12 IC-BPB patients, 9 IVRA patients and 5 WALANT patients. Of these patients, 6 undergoing IC-BPB, 5 undergoing IVRA and 4 undergoing WALANT were converted to general anesthesia (p = 0.80). PACU time and anesthesia costs were the least in the WALANT group, followed by the IVRA group (p < 0.001, p < 0.001). Intraoperative active voluntary movements were best preserved in the WALANT group; however, bleeding was highest in the WALANT group (p < 0.001, p < 0.001). Tourniquet pain was the higher in the IVRA groups, while postoperative pain in the surgical area developed the fastest in this same group (p = 0.029, p < 0.001). Time to discharge was similar in WALANT and IVRA groups, and the longest in the IC-BPB (p < 0.001) group. There was no difference among the groups in terms of patient satisfaction (p = 0.085, p = 0.242 for the first and second survey question). In the current study, WALANT appears to be a suitable alternative to IVRA and IC-BPB methods, with better preservation of active intraoperative movement, lower cost, and shorter time spent in PACU at the expense of higher bleeding.