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  1. Description of WALANT technique in open bone and ligament wrist surgery
    Brutus JP, Chang MC, Ahmad AA, Apard T
    Hand Surg Rehabil, 2024 Feb;43(1):101610.
    PMID: 38393765 DOI: 10.1016/j.hansur.2023.10.004
    The gold-standard for bone, ligament and joint surgery in the wrist is locoregional anesthesia in most countries. Wide-Awake Local Anesthesia No Tourniquet (WALANT) is commonly used for simple soft-tissue hand surgery procedures such as carpal tunnel or trigger finger release, and can now also be safely used in procedures such as proximal row carpectomy, scapholunate ligament repair or partial wrist fusion, to name but a few. This article describes the use of WALANT for complex surgery in the wrist. WALANT surgery offers many known benefits, such as enhanced patient safety and comfort, simplified perioperative process and avoidance of anesthesia-related risks, and also allows the surgeon to perform intraoperative testing of the repaired structures. Thus, the surgeon can tailor the rehabilitation program and shorten recovery time. We describe detailed guidelines for performing WALANT procedures safely and effectively, making it a favorable option for complex surgeries in the wrist.
  2. Fulltext Patients Tracking Pain Episodes Show Wide-awake Local Anesthesia Without Tourniquet Can Be Nearly Painless
    Brutus JP, Ahmad AA, Apard T, Tchiloemba B, Chang MC, Lalonde DH
    Plast Reconstr Surg Glob Open, 2025 Mar;13(3):e6568.
    PMID: 40125471 DOI: 10.1097/GOX.0000000000006568
    BACKGROUND: Minimally painful tumescent local anesthesia ensures patients feel only the first needle insertion, with no further pain. This technique includes real-time patient feedback, where they report each pain event during injection.

    METHODS: This prospective study involved 154 consecutive patients undergoing wide-awake local anesthesia no tourniquet surgery at 3 hand surgery centers (January-April 2024). Patients objectively scored pain events during injection and rated pain intensity (0-10 Likert scale), intraoperative pain, anxiety, and overall experience.

    RESULTS: During local anesthesia injection, 61 (40%) patients reported no pain, 92 (59.7%) reported 1 pain event, and 1 (0.7%) patient reported 2 events. Among the 93 patients who felt pain, 90 reported only mild discomfort (1-2 of 10), whereas 3 reported moderate pain (3-5 of 10). Anxiety levels during anesthesia and surgery were 3 of 10 or less for 147 (95.5%) patients.

    CONCLUSIONS: Real-time patient feedback improved surgeons' ability to administer tumescent local anesthesia with minimal pain. As a result, most patients experienced no pain or only 1 minor event during local anesthesia injection for wide-awake local anesthesia no tourniquet surgery.

  3. Efficacy of rabbit antithymocyte globulin as first-line treatment of severe aplastic anemia: an Asian multicenter retrospective study
    Chuncharunee S, Wong R, Rojnuckarin P, Chang CS, Chang KM, Lu MY, et al.
    Int J Hematol, 2016 Oct;104(4):454-61.
    PMID: 27376944 DOI: 10.1007/s12185-016-2053-8
    Due to the unavailability of horse antithymocyte globulin (ATG) in many markets worldwide, patients with severe aplastic anemia (SAA) are limited to the use of rabbit ATG. We aimed to analyze hematologic response and overall survival (OS) of Asian patients treated with rabbit ATG as first-line therapy of SAA. We retrospectively reviewed the medical records of 97 consecutive patients who received rabbit ATG as first-line treatment of SAA from 2006 to 2012 at centers in four Asian countries. The primary endpoint was 6- and 12-month overall response rates (ORR) for patients receiving rabbit ATG within the recommended dose range (2.5-3.75 mg/kg/day). Secondary endpoints included ORR in patients receiving any dose of rabbit ATG and 2-year OS. For patients who received rabbit ATG within the recommended dose range, 6- and 12-month ORRs were 17.4 and 63.6 %, respectively. For patients who received any dose of rabbit ATG, 6- and 12-month ORRs were 24.3 and 68.6 %, respectively. The 2-year OS rate was 86.3 %. Rabbit ATG is effective for treatment of SAA in Asian patients. The 12-month ORR and 2-year OS with rabbit ATG were comparable to historical results obtained with horse ATG.
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