Abdullah Örs, Özgür Çakır, Can Aksu, Hadi Ufuk Yörükoğlu, Volkan Alparslan, Serdar Demiröz, Tuncay Çolak, Alparslan Kuş
Kocaeli Üniversitesi Sağlık Bilimleri Dergisi - 2025;11(3):167-170
Objective: The WALANT (Wide Awake Local Anesthesia No Tourniquet) technique has gained popularity in hand surgery due to its simplicity, cost-effectiveness, and elimination of tourniquet-related discomfort. Despite its widespread use, the anatomical accuracy of anesthetic spread between ultrasound-guided (USG) and landmark-based WALANT injections remains underexplored. This study aims to compare the anatomical distribution and perineural coverage of anesthetic solution delivered via ultrasound-guided versus landmark-based WALANT techniques using computed tomography (CT) and magnetic resonance imaging (MRI) in a cadaveric model. Methods: WALANT injections were performed on a formalin-fixed female cadaver. The right upper limb received a USG-guided injection, while the left received an injection based on anatomical landmarks. A radiopaque contrast-containing solution was used. CT and 1.5 T MRI scans were acquired to evaluate distribution patterns in axial, coronal, and sagittal planes. Results : USG-guided injection demonstrated a more compact, deeper, and anatomically precise distribution, particularly with pronounced perineural spread around the median nerve within the carpal tunnel. The landmark-based technique showed broader but less focused spread, extending to superficial planes with less perineural accumulation. Conclusion: Ultrasound-guided WALANT injection provides superior anatomical targeting and perineural anesthetic coverage compared to the landmark-based technique. Routine use of ultrasound guidance in WALANT procedures is recommended to enhance effectiveness and reduce anatomical variation-related complications.
