Dear Sir,
Currently the COVID-19 pandemic is putting significant strain on the healthcare systems across the globe. Our anaesthetic colleagues are under immense pressure and in some instances have been redeployed to other settings, limiting our ability to operate under general or regional anaesthesia. We propose that training in both wide awake local anaesthesia no tourniquet (WALANT) as well as ultrasound guided blocks should be incorporated into plastic surgery training or at the very least in to the hand surgery subspecialty curriculum to help overcome such a problem in the future.
As a limb salvage team, we have a duty to continue our service during these dire times. To facilitate continued surgical treatment with limited anaesthetic cover, other options should be explored. This view also been supported by the BAPRAS/BSSH Coronavirus pandemic management recommendations for hand injuries.1 One of the suggestions is to use the WALANT approach.2 This technique has widely documented safety 3 and utilises tumescent infiltration of 1% lignocaine with 1:200000 adrenaline. Interestingly, most UK trainees use a variation of this technique during open carpal tunnel decompression surgery, yet are not comfortable repairing flexor tendons using such an approach. This is for the most part due to the unfamiliarity of the technique as well as the dogma of not using adrenaline in the fingers which has been refuted.4 In the coming weeks, this skill set might make a huge difference in the amount of resources required to maintain a safe and efficient upper limb trauma service, allowing for more injuries to be treated in minor ops theatres provided the right equipment is available.
We therefore propose that WALANT should be incorporated into plastic surgery training curriculum. We recognise that it might not be an approach favoured by all once the pandemic is over however, increasing the variety of skills taught to future plastic surgeons should be encouraged. Furthermore, the Hand Diploma or subspecialty interest in hand surgery curriculum could include training on regional ultrasound guided blocks. This should mainly be as an adjunct for smaller cases with regional anaesthesia remaining under the domain of our anaesthetic colleagues.
Declaration of Competing Interest
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Funding
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Footnotes
Content or abstract has not been presented at any meetings.
References
- 1.Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic [Internet]. [cited 2020 Mar 31]. Available from: http://www.bapras.org.uk/docs/default-source/covid-19-docs/final-boast-doc—badged.pdf?sfvrsn=2
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