Research led by clinicians at the UK’s Royal Free Hospital has demonstrated the success of a new surgical technique for repairing hand tendons.
The WAFER trial, funded by the National Institute of Health and Care Research, found that using local rather than general anaesthesia when repairing patients’ tendons led to a faster recovery.
The multicentre trial involved four major units in the UK, including Manchester University NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust and Barts Health NHS Trust, alongside the Royal Free London (RFL).
The research is the first of its kind in Europe to test the effectiveness and safety of using local anaesthesia for surgery to repair flexor tendons in the hand.
Flexor tendons run from the forearm to the fingertips, and when damaged, can leave individuals unable to bend their fingers or grip objects. Tendon injuries are among the most common reasons patients present to emergency departments worldwide.
Originally launched in 2021, the study investigated the outcomes, recovery times and costs of surgery to repair these tendons under general or local anaesthesia for more than 60 patients.
Patients undergoing the new surgical technique, called wide awake local anaesthesia no tourniquet (WALANT), receive local anaesthesia to numb the arm alongside adrenaline. This technique was compared to the traditional method, in which patients receive general anaesthesia or a full anaesthetic of the arm.
The results found that patients who underwent the WALANT procedure returned to work, on average, three and a half weeks sooner than those who had general anaesthesia.
As well as its patient benefits, the use of local anaesthetic requires fewer staff in theatres and has lower operating costs. Patients were able to return home as soon as their operation was complete, rather than waiting for the anaesthetic to wear off.
Both methods produced the same clinical outcomes, with patients reporting the same range of motion six months later, making the use of local anaesthetic a safe and efficient option for clinicians.
Research lead and consultant plastic surgeon Dariush Nikkhah said: “It’s incredibly exciting for the trust and the NHS to be leading this research. Using local anaesthesia for these procedures means we can talk to patients while operating to test their tendon repairs. We can also see more patients, as we’re less reliant on anaesthetic departments, and use fewer resources. It’s an example of great clinical research, which is a big part of our trust’s mission.’
The WALANT trial has now been published in the international Plastic and Reconstructive Surgery journal.
