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Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine.
J Hand Surg Am. 2020 Jun; 45(6):554.e1-554.e6.JH

Abstract

PURPOSE

Wide-awake local anesthesia no tourniquet (WALANT) is an increasingly popular surgical technique. However, owing to surgeon preference, patient factors, or hospital guidelines, it may not be feasible to inject patients with solutions containing epinephrine the recommended 25 minutes prior to incision. The purpose of this study was to assess pain and patient experience after short hand surgeries done under local anesthesia using a tourniquet rather than epinephrine for hemostasis.

METHODS

Ninety-six consecutive patients undergoing short hand procedures using only local anesthesia and a tourniquet (LA-T) were assessed before and after surgery. A high arm pneumatic tourniquet was used in 73 patients and a forearm pneumatic tourniquet was used in 23. All patients received a local, unbuffered plain lidocaine injection. No patients received sedation. Pain related to local anesthesia, pneumatic tourniquet, and the procedure was assessed using a visual analog scale (VAS). Patient experience was assessed using a study-specific questionnaire based on previous WALANT studies. Tourniquet times were recorded.

RESULTS

Mean pain related to anesthetic injection was rated 3.9 out of 10. Mean tourniquet related pain was 2.9 out of 10 for high arm pneumatic tourniquets and 2.3 out of 10 for forearm pneumatic tourniquets. Patients rated their experience with LA-T favorably and 95 of 96 patients (99%) reported that they would choose LA-T again for an equivalent procedure. Mean tourniquet time was 9.6 minutes and only 1 patient had a tourniquet inflated for more than 20 minutes. Tourniquet times less than 10 minutes were associated with less pain than tourniquet times greater than 10 minutes (P < .05); however, both groups reported the tourniquet to be on average less painful than the local anesthetic injection.

CONCLUSION

Short wide-awake procedures using a tourniquet are feasible and well accepted. Local anesthetic injection was reported to be more painful than pneumatic tourniquet use. Tourniquets for short wide-awake procedures can be used in settings in which preprocedure epinephrine injections are logistically difficult or based on surgeon preference.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Authors+Show Affiliations

Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY. Electronic address: Nader.Paksima@nyumc.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31924434

Citation

Shulman, Brandon S., et al. "Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine." The Journal of Hand Surgery, vol. 45, no. 6, 2020, pp. 554.e1-554.e6.
Shulman BS, Rettig M, Yang SS, et al. Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine. J Hand Surg Am. 2020;45(6):554.e1-554.e6.
Shulman, B. S., Rettig, M., Yang, S. S., Sapienza, A., Bosco, J., & Paksima, N. (2020). Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine. The Journal of Hand Surgery, 45(6), e1-e6. https://doi.org/10.1016/j.jhsa.2019.10.035
Shulman BS, et al. Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine. J Hand Surg Am. 2020;45(6):554.e1-554.e6. PubMed PMID: 31924434.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine. AU - Shulman,Brandon S, AU - Rettig,Michael, AU - Yang,S Steven, AU - Sapienza,Anthony, AU - Bosco,Joseph, AU - Paksima,Nader, Y1 - 2020/01/08/ PY - 2018/09/09/received PY - 2019/08/23/revised PY - 2019/10/30/accepted PY - 2020/1/12/pubmed PY - 2020/1/12/medline PY - 2020/1/12/entrez KW - Hand surgery KW - WALANT KW - local anesthesia KW - tourniquet KW - wide awake SP - 554.e1 EP - 554.e6 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 45 IS - 6 N2 - PURPOSE: Wide-awake local anesthesia no tourniquet (WALANT) is an increasingly popular surgical technique. However, owing to surgeon preference, patient factors, or hospital guidelines, it may not be feasible to inject patients with solutions containing epinephrine the recommended 25 minutes prior to incision. The purpose of this study was to assess pain and patient experience after short hand surgeries done under local anesthesia using a tourniquet rather than epinephrine for hemostasis. METHODS: Ninety-six consecutive patients undergoing short hand procedures using only local anesthesia and a tourniquet (LA-T) were assessed before and after surgery. A high arm pneumatic tourniquet was used in 73 patients and a forearm pneumatic tourniquet was used in 23. All patients received a local, unbuffered plain lidocaine injection. No patients received sedation. Pain related to local anesthesia, pneumatic tourniquet, and the procedure was assessed using a visual analog scale (VAS). Patient experience was assessed using a study-specific questionnaire based on previous WALANT studies. Tourniquet times were recorded. RESULTS: Mean pain related to anesthetic injection was rated 3.9 out of 10. Mean tourniquet related pain was 2.9 out of 10 for high arm pneumatic tourniquets and 2.3 out of 10 for forearm pneumatic tourniquets. Patients rated their experience with LA-T favorably and 95 of 96 patients (99%) reported that they would choose LA-T again for an equivalent procedure. Mean tourniquet time was 9.6 minutes and only 1 patient had a tourniquet inflated for more than 20 minutes. Tourniquet times less than 10 minutes were associated with less pain than tourniquet times greater than 10 minutes (P < .05); however, both groups reported the tourniquet to be on average less painful than the local anesthetic injection. CONCLUSION: Short wide-awake procedures using a tourniquet are feasible and well accepted. Local anesthetic injection was reported to be more painful than pneumatic tourniquet use. Tourniquets for short wide-awake procedures can be used in settings in which preprocedure epinephrine injections are logistically difficult or based on surgeon preference. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/31924434/Tourniquet_Use_for_Short_Hand_Surgery_Procedures_Done_Under_Local_Anesthesia_Without_Epinephrine_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(19)31479-0 DB - PRIME DP - Unbound Medicine ER -
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