Razavi Journal of Medicine

Razavi Journal of Medicine

Comparison of Complex Regional Pain Syndrome Prevalence Between WALANT and Regional Anesthesia in Distal Radius Fracture Surgery

Document Type : Original Article

Authors
Saber Barazandeh Rad 1
Babak Toloue Ghamari 1
Mehrdad Sadighi 1
Amir Sabaghzadeh 1
Farsad Biglari 1
Meisam Jafari Kafiabadi 1
Mohammad Akhbari 2
Adel Ebrahimpour 1
1 Department of Orthopedic Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
10.30483/rjm.2026.254684.1454
Abstract
Background: Distal radius fractures are among the most common skeletal injuries that require surgical intervention. This study compares the Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique with regional anesthesia with respect to surgical outcomes and the incidence of complex regional pain syndrome (CRPS).
 
Objective: This study aimed to compare the Wide-Awake Local Anaesthesia No Tourniquet (WALANT) technique with regional anaesthesia in patients undergoing distal radius fracture surgery. Specifically, it evaluated differences in surgical outcomes, including intraoperative blood loss, duration of surgery, postoperative pain, and changes in haemoglobin, and assessed the incidence of complex regional pain syndrome (CRPS) between the two groups. The findings were intended to inform clinical decision-making regarding anaesthesia selection for this common orthopaedic procedure.
 
Methods: In this Non-Randomized Clinical Trial, 59 patients with distal radius fractures were divided into two groups: 30 received WALANT, and 29 received regional anesthesia. Outcomes assessed included intraoperative blood loss, hemoglobin drop, postoperative pain (VAS score), surgery duration, and CRPS incidence.
 
Results: Blood loss was higher in the WALANT group (147 mL, SD = 29) compared to the regional anesthesia group (121 mL, SD = 39; p = 0.005). Hemoglobin drop was similar between groups (1.3 g/dL, SD = 2.2 vs. 1.0 g/dL, SD = 0.2; p = 0.574). Postoperative pain scores showed no significant difference (1.60, SD = 1.16 vs. 1.07, SD = 0.80; p = 0.081). Surgery duration was significantly shorter in the WALANT group (138 min, SD = 33 vs. 157 min, SD = 24; p = 0.022). CRPS incidence was lower in the WALANT group (30%) than in the regional anesthesia group (37.9%), but the difference was not statistically significant (p = 0.52).
 
Conclusion: Both WALANT and regional anesthesia are safe and effective for distal radius fracture surgery. WALANT offers a shorter surgical time and eliminates the need for a tourniquet, despite higher blood loss. It may be a viable and efficient alternative.
Keywords
Distal radius fracture
Wide-Awake Local Anesthesia No Tourniquet
regional anesthesia
complex regional pain syndrome

Acknowledgements: Not applicable.

 

Availability of data and materials: Information on where data supporting the results reported in the article can be found and made available by the corresponding author.

 

Conflicts of interests: The authors declare no conflicts of interest related to the design, conduct, analysis, or reporting of this study.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: All procedures performed in this study involving human participants were by the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards and were approved by the Research Ethics Committee of the Faculty of Medicine, Shahid Beheshti University of Medical Sciences. (approval code: IR.SBMU.MSP.REC.1403.567).The study's objectives and procedures were clearly explained to all participants, and written informed consent was obtained.

 

Financial disclosure: This study received no external funding. All research-related expenses were covered internally, and commercial or institutional sponsors provided no financial support.

 

Author contributions: Conception and design of the study: Meisam Jafari Kafiabadi, Farsad Biglari Acquisition of data: Amir Sabaghzadeh, Saber Barazandeh Rad Data analysis: Mehrdad Sadighi, Mohammad Akhbari Final approval of the version to be submitted: Meisam Jafari Kafiabadi, Babak Toloue Ghamari, Adel Ebrahimpour.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine
Volume 14, Issue 2
Spring 2026
Pages 54-63