Dear all

I was asked to put together some guidelines on WALANT for us all as we end up without anaesthetists for many cases.  Whilst we still have anaesthetists this is a good time to practise and get good at the technique.

We can all do Field blocks and have done since we were house officers.  This is just a field block with adrenaline.

I suggest (from experience) that premixed Lignocaine and Adrenaline does not work and prefer to mix my own.  How much to use?  1:200,000 or weaker.  Don Lalonde goes as low as 1:400,000.  I have a standard way of mixing my Adrenaline.  If you use 20 ml of 1% Lignocaine with 0,1ml of 1:1000 Adrenaline then you have the correct dilution and you can use up to 40mls of this mixture.

Recognise that this is not a bloodless field but an acceptable field!  Wait 30 minutes or even longer.  This is Mandatory.  I generally go onto the ward and inject the next but one patient in the side room, come back and do the case and then go and block the next but one again and so on so each patient has time to cook.

Apply a forearm tourniquet before starting the procedure but do not inflate, it is there for problems.  Recognise that deep tissues may be subject to pain from stretch, etc.  Trapeziectomy frequently needs extra as the deep aspects are avulsed from the ligaments.

I have downloaded to dropbox the Lalonde powerpoint

https://www.dropbox.com/s/yrtgoy5l2o7jbu6/How%20to%20inject%20minimal%20pain%20local%20anesthesia.pptx?dl=0

This is a large file so only open on wifi!!

Also his primary paper

https://www.dropbox.com/s/sf4skaju5vlxx1v/Wide-awake-Hand-and-Wrist-Surgery-A-New-Horizon-in-Outpatient-Surgery.pdf?dl=0

Chris Bainbridge
Visiting Professor of Hand Surgery, University of Derby
Honorary (Consultant) Assistant Professor, University of Nottingham
Consultant Hand Surgeon and Lead for Hand Surgery Research
Pulvertaft Hand Centre Royal Derby Hospital