Ann Clin Anesth Res | Volume 2, Issue 2 | Case Study | Open Access

Titrated Axillary Block Like an Alternative of WALANT Technique

Thierry Garnaud1* and Julien Toulemonde2

1Department of Anaesthesiology, Rodez General Hospital, France
2Department of Orthopaedic Surgery, Rodez General Hospital, France

*Correspondance to: Thierry Garnaud 

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Purpose: The WALANT technique is an anaesthetic method for soft tissue surgery of the hand and forearm. Despite having been described several years ago its use in the orthopaedic or anaesthetic community is far from being commonplace. One of its most important features is to maintain an active voluntary contraction of the patient’s muscles during surgery. In the absence of health professionals having an expertise in this technique there is an alternative that we describe in this paper: the titrated axillary block. Clinical Features: A 47-year-old man underwent a forearm tendon transfer surgery. The orthopaedic stand anaesthetist taking care of this patient was not experts in the WALANT technique. After the accurate assessment of the surgical procedure, an axillary block was performed in two steps. Firstly, a single injection of local anaesthetics was progressively achieved around the musculocutaneous nerve, then the radial nerve and finally the ulnar nerve to induce a complete sensory and motor block in these nerves areas. Secondly, a perineural catheter was placed near the median nerve allowing a titrated injection of lidocaine. A 50 minutes tourniquet was used during the surgery. Upon tourniquet deflation the patient recovered his flexor muscles motricity. The surgeon could adjust his suture tension. The postoperative period was uneventful and the perineural catheter was used for pain control.
Conclusion: When WALANT technique is not available or mastered there is still a role for loco regional anaesthesia in reconstructive orthopaedic surgery of the upper limb to maintain an active voluntary muscle contraction during the procedure.


Garnaud T, Toulemonde J. Titrated Axillary Block Like an Alternative of WALANT Technique. Ann Clin Anesth Res. 2018; 2(2): 1015.

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