Tags

Type your tag names separated by a space and hit enter

A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline.
J Orthop Surg (Hong Kong). 2019 Jan-Apr; 27(1):2309499019833002.JO

Abstract

BACKGROUND

Trigger finger release utilizing wide-awake local anesthesia no tourniquet (WALANT) usage in extremity surgery is not widely used in our setting due to the possibility of necrosis. Usage of a tourniquet is generally acceptable for providing surgical field hemostasis. We evaluate hemostasis score, surgical field visibility, onset and duration of anesthesia, pain score, and the duration of surgery and potential side effects of WALANT.

METHODS

Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1-10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded.

RESULTS

Hemostasis score was grouped into visibility score as 1-3: good, 4-6: moderate, and 7-10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference.

CONCLUSION

WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.

Authors+Show Affiliations

Hand and Microsurgery Unit, Department of Orthopedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.Hand and Microsurgery Unit, Department of Orthopedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.Hand and Microsurgery Unit, Department of Orthopedics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30852960

Citation

Mohd Rashid, Mohd Zaim, et al. "A Randomized Controlled Trial of Trigger Finger Release Under Digital Anesthesia With (WALANT) and Without Adrenaline." Journal of Orthopaedic Surgery (Hong Kong), vol. 27, no. 1, 2019, p. 2309499019833002.
Mohd Rashid MZ, Sapuan J, Abdullah S. A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline. J Orthop Surg (Hong Kong). 2019;27(1):2309499019833002.
Mohd Rashid, M. Z., Sapuan, J., & Abdullah, S. (2019). A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline. Journal of Orthopaedic Surgery (Hong Kong), 27(1), 2309499019833002. https://doi.org/10.1177/2309499019833002
Mohd Rashid MZ, Sapuan J, Abdullah S. A Randomized Controlled Trial of Trigger Finger Release Under Digital Anesthesia With (WALANT) and Without Adrenaline. J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019833002. PubMed PMID: 30852960.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized controlled trial of trigger finger release under digital anesthesia with (WALANT) and without adrenaline. AU - Mohd Rashid,Mohd Zaim, AU - Sapuan,Jamari, AU - Abdullah,Shalimar, PY - 2019/3/12/entrez PY - 2019/3/12/pubmed PY - 2020/3/26/medline KW - WALANT KW - adrenaline KW - hemostasis KW - local anesthesia KW - trigger finger KW - trigger release SP - 2309499019833002 EP - 2309499019833002 JF - Journal of orthopaedic surgery (Hong Kong) JO - J Orthop Surg (Hong Kong) VL - 27 IS - 1 N2 - BACKGROUND: Trigger finger release utilizing wide-awake local anesthesia no tourniquet (WALANT) usage in extremity surgery is not widely used in our setting due to the possibility of necrosis. Usage of a tourniquet is generally acceptable for providing surgical field hemostasis. We evaluate hemostasis score, surgical field visibility, onset and duration of anesthesia, pain score, and the duration of surgery and potential side effects of WALANT. METHODS: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1-10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded. RESULTS: Hemostasis score was grouped into visibility score as 1-3: good, 4-6: moderate, and 7-10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference. CONCLUSION: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort. SN - 2309-4990 UR - https://www.unboundmedicine.com/medline/citation/30852960/A_randomized_controlled_trial_of_trigger_finger_release_under_digital_anesthesia_with__WALANT__and_without_adrenaline_ L2 - https://journals.sagepub.com/doi/10.1177/2309499019833002?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -