HOW TO EXPLAIN WALANT TO CHILDREN BEFORE YOU INJECT THE LOCAL ANESTHETIC

Children do very well with WALANT hand surgery. The key is to provide good local anesthesia (see Chapter 5) with a skillful injection so that all they feel is the first sting of a 30-gauge needle.

• 
  

  The most important factor in gaining the patient′s trust and cooperation is how you talk to the child before you inject the local anesthetic. Using a calm, soft-spoken voice with a gentle manner and engaging conversation is very helpful. If you are not comfortable having a prolonged conversation with the child you are about to operate on, perhaps you should plan on performing the surgery with the patient under general anesthesia.

  
  
• 
  

  The child must be old enough to understand your explanation and to hold still while you insert the first needle.

  
  
• 
  

  If you can get the child to hold still to tolerate the stick of a 30-gauge needle in the finger or hand, you can perform the surgery with WALANT.

The following approach works well with children: “Do you believe in magic?”

Most children will say, “No.”

“Neither do I, but today I am going to show you some real magic. I am going to put some magic medicine underneath your skin. After I put it there, I will be able to fix your finger and it WILL NOT HURT AT ALL. I PROMISE YOU.

The only problem with putting in the magic medicine is that you have to feel one tiny needle stick to get the medicine in there. All you need to do is hold still and not move.

I will help you by holding your hand.

If you pull your hand away before the medicine goes in, the needle will come out and I will have to stick it back in.

If you hold still, you will only feel one little sting. If you move, you will feel two stings.

Do you think you can hold still?”

• 
  

  If the child gets that panicked look in the eyes that indicates he or she cannot hold still for the injection, general anesthesia is advisable.

  
  
• 
  

  You need to keep your promise by making certain that all the child feels is the first sting, as shown in Chapter 5. Be sure that you have more than enough volume of anesthetic rather than not enough. Children should not have to have “top-ups.”

  
  
• 
  

  I usually have my body between the patient′s eyes and her hands. Note that in Clip 9-2 my body is in an awkward position on the wrong side of the table for this video so you can see the patient and the injection.

  
  
• 
  

  After you inject the local anesthetic, this is what you can tell the patient:

“I told you all you would feel was one little stick and then no pain.

I was not lying, was I?”

They say, “No.”

“I am not lying now. The surgery will not hurt you one little bit now that the magic medicine is in there.”

• 
  

  You can establish a wonderful relationship with most children during WALANT surgery.

  
  
• 
  

  You can avoid all the risks and inconveniences of pediatric sedation and general anesthesia for many cases.

  
  
• 
  

  The same benefits of the patient′s seeing active movement in an operation such as flexor tendon repair or a finger fracture holds true for children as for adults.