The term WALANT refers to an anesthesia technique whose principle, similar to that of tumescent local anesthesia, is based on the infiltration of a solution of local anesthetics combined with a vasoconstrictor (adrenaline) into the surgical site, making it possible to avoid the need for a pneumatic tourniquet. Concept initially described by dermatologist Jeffrey Klein in cosmetic surgery [1] , it was under the impetus of Donald Lalonde, a Canadian hand surgeon, that WALANT was developed and promoted from the 1980s [2] .

This technique of anesthesia by tumescence of the hand with xylocaine, which does without a tourniquet thanks to adrenaline, allows the patient, fully conscious during the operation, to make voluntary movements with his hand at the request of the surgeon.

The patient can then adapt the surgery and begin giving post-operative instructions to the patient. The patient’s attention is then maximized, and the “link” between patient and caregiver is not broken during the procedure. [3] .

This technique is not known in Guinea where general anesthesia and, to a lesser extent, locoregional anesthesia (LRA) are the only techniques for any thoracic limb surgery. We report the functional results in the per and immediate postoperative period of surgical management of fractures of the distal end of the radius under the WALANT.

The average time for surgical treatment was 8 hours.

The mean VAS during the surgical procedure was 2.3 (+/−1.6).

The average intervention time was 17 minutes.

Dorsiflexion was between 60 - 70 (9 patients), 50 - 60 (3 patients); palmar flexion between 60 - 80 (10 patients), 58 (2 patients). The inclinations were on average 13 radial and 38 ulnar.

The time spent in the recovery room was on average 30 minutes.

The patient satisfaction rate was 96%.

The average length of hospital stay was 2 days.

The local anesthetic solution used ranged from 30 ml to 40 ml. After administering the anesthetic solution without a tourniquet, we waited 30 minutes to begin trimming and/or reduction and pinning. This technique allowed us to achieve hemostasis and painlessness throughout the surgery (trimming, reduction, pinning).

Adrenaline-induced vasoconstriction is observed after a delay of approximately 25 minutes between infiltration and surgery. This is the time required to reach the peak of the vasoconstrictor effect of adrenaline and thus obtain the best operating conditions [4] .

For Lalonde [5] , the discomfort of the tourniquet is very unpleasant and unnecessary for patients.

Studies by Iqbal et al. [6] indicate that the use of a tourniquet causes unnecessary pain intraoperatively with little identifiable benefit compared to the same surgery without the use of a tourniquet. In studies by Lee DC [7] and Ruxasagulwong S [8] , it has been shown that removing the need for a tourniquet by adding adrenaline is less painful for patients with lower VAS scores, in addition to reducing total blood loss.

In our study, the average intervention time was 17 minutes and the patient satisfaction rate was 96%. The absence of pain and the patient’s participation in the procedure explains this result. Indeed, he maintains control of his limb and helps with the installation and preparation of the limb for the procedure. It can also [9] at the surgeon’s request, perform intraoperative mobilizations in order to test a tendon repair, validate the positioning of osteosynthesis material or a joint prosthesis.

Hugo Z’s studies [10] showed advantages related to the WALANT technique by anesthesiologists: the absence of motor block, surgeon satisfaction and patient comfort. Accelerated discharge from hospital and safety of use were also put forward.

A randomized study [11] compared WALANT with local intravenous anesthesia[] (ALRIV or Bier block) and showed superiority of WALANT in terms of peri- and post-operative pain control, duration in the operating room and use of post-operative analgesics. Several studies, with large groups of patients and using the mixture proposed by Donald Lalonde’s team, have shown an absence of risk of necrosis [2] [5] . Rare clinical cases published recently [12] - [14] , report the appearance of digital necrosis after infiltration of adrenaline solution (10 ug/mL). It should be noted, however, that the patients concerned presented with particular vascular conditions (Raynaud’s syndrome, severe arteriopathy).

WALANT is a reliable, inexpensive, and safe technique. It allows for intraoperative wrist functional assessment. Today, it should be part of our therapeutic arsenal in the surgical treatment of EDR fractures.

Sory S: main author, designer of the data sheet, initiation of the work and writing of the article;

Diallo AMF: Using files and filling out forms;

Tafsir C: Using files and filling out forms;

Diouf AB: Statistical study;

Amira A: Statistical study;

Koivogui B: Statistical study;

Alhassane, B: Correction;

Leopold L: Correction.