Abstract

Aim: Wide-awake local anesthesia with no tourniquet (WALANT) is increasingly used in surgical practice due to its safety profile, reduced resource requirements, and elimination of sedation. Although widely studied in hand surgery, its role in emergency thoracic procedures remains unclear. This study aimed to compare the efficacy of WALANT and lidocaine-based local anesthesia in patients undergoing emergency tube thoracostomy, focusing on pain perception, bleeding-related complications, and clinical outcomes.
Materials and Methods: This prospective, single-blind, controlled study was conducted between November 1, 2023, and August 1, 2024, in the emergency medicine and thoracic surgery clinics of a tertiary care hospital. Sixty-six adult patients requiring chest tube placement were included and randomized based on medical record number parity into two groups: WALANT (n = 33) and lidocaine local anesthesia (n = 33). The WALANT solution consisted of lidocaine, isotonic saline, sodium bicarbonate, and epinephrine. Pain was assessed using the Visual Analog Scale (VAS) before and five minutes after the procedure. Bleeding-related complications and demographic variables were recorded. Statistical significance was set at p < 0.05.
Results: The mean age of participants was 46 ± 20 years; 78.8% were male. Indications included spontaneous pneumothorax (37.9%), traumatic pneumothorax (22.7%), malignant effusion (21.2%), hemothorax (10.6%), and empyema (7.6%). A statistically significant reduction in VAS scores was observed when comparing pre- and post-procedural pain between groups (p = 0.004). WALANT demonstrated significant pain reduction particularly in patients with traumatic pneumothorax (p = 0.01). No severe bleeding complications were observed in either group, including patients receiving anticoagulant or antiplatelet therapy.
Conclusion: WALANT appears to be a safe and effective alternative to lidocaine-based local anesthesia for emergency tube thoracostomy. It provides significant analgesic benefit without increasing bleeding-related complications and may be particularly advantageous in trauma-related thoracic injuries. Further studies incorporating patient-reported outcomes and long-term follow-up are warranted.

Key words: Anesthesia, Local, tube thoracostomy, local anesthesia, pneumothorax, emergency medicine, thoracic procedures