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A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet.
Orthop Traumatol Surg Res. 2020 Jul 03 [Online ahead of print]OT

Abstract

INTRODUCTION

Epinephrine and sodium bicarbonate (NaHCO3) used in wide-awake local anesthesia no tourniquet (WALANT) affect many areas such as hemostasis, injection pain, anesthetic effect and others. However, few clinical trials have focused on injection pain and the duration of anesthetic effect, and no prospective studies have reported the benefits of WALANT post operation. This study compared WALANT with conventional local anesthesia with tourniquet in minor hand surgeries, and aimed to answer following questions: (1) Does WALANT have enough benefits for injection pain and duration of anesthetic effect?; (2) How does WALANT affect postoperative management (such as postoperative pain and use of analgesics)?; (3) How satisfied are the patients with the surgery?

HYPOTHESIS

We hypothesized that WALANT had advantages in injection pain, duration of anesthetic effect, and postoperative management compared to conventional local anesthesia.

MATERIALS AND METHODS

The present study is designed as a randomized prospective one center study. This study included 185 patients who received surgical treatment for the diagnosis of carpal tunnel syndrome, trigger finger, or de Quervain's disease between 2017 and 2019. We randomly allocated the patients to either the WALANT group or the conventional group. We inquired and recorded patients' injection pain, duration of anesthetic effect, postoperative pain, the use of analgesics, and satisfaction with the surgery.

RESULTS

The injection pain was significantly lower in the WALANT group in all procedures (p<0.001). The duration of anesthetic effect was significantly longer in the WALANT group in all procedures (p<0.001). As for the postoperative management of all procedures, the pain score was significantly lower in the WALANT group until the first day after surgery, with the biggest difference at 6hours after surgery. The use of analgesics was significantly lower in the WALANT group until the second day after surgery. Satisfaction with surgery was significantly higher in the WALANT group in all procedures: A1 pulley release (p=0.026), 1st extensor retinaculum (p=0.045), and carpal tunnel release (p=0.003).

DISCUSSION

Our study showed better results in WALANT than in the conventional method, with no tourniquet pain, lower injection pains, longer anesthetic duration, and less postoperative pain. It provided patients with great satisfaction. In addition, WALANT has the potential benefits of no time limit due to tourniquet pain and long anesthetic effect. Therefore, WALANT is comfortable and cost effective, and could be a good alternative to conventional local lidocaine anesthesia.

LEVEL OF EVIDENCE

II.

Authors+Show Affiliations

Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea. Electronic address: sklee@eulji.ac.kr.Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32631713

Citation

Ki Lee, Sang, et al. "A Randomized Controlled Trial of Minor Hand Surgeries Comparing Wide Awake Local Anesthesia No Tourniquet and Local Anesthesia With Tourniquet." Orthopaedics & Traumatology, Surgery & Research : OTSR, 2020.
Ki Lee S, Gul Kim S, Sik Choy W. A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet. Orthop Traumatol Surg Res. 2020.
Ki Lee, S., Gul Kim, S., & Sik Choy, W. (2020). A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet. Orthopaedics & Traumatology, Surgery & Research : OTSR. https://doi.org/10.1016/j.otsr.2020.03.013
Ki Lee S, Gul Kim S, Sik Choy W. A Randomized Controlled Trial of Minor Hand Surgeries Comparing Wide Awake Local Anesthesia No Tourniquet and Local Anesthesia With Tourniquet. Orthop Traumatol Surg Res. 2020 Jul 3; PubMed PMID: 32631713.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet. AU - Ki Lee,Sang, AU - Gul Kim,Sung, AU - Sik Choy,Won, Y1 - 2020/07/03/ PY - 2020/01/05/received PY - 2020/02/10/revised PY - 2020/03/11/accepted PY - 2020/7/8/entrez KW - Epinephrine KW - Lidocaine KW - Sodium bicarbonate KW - WALANT JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res N2 - INTRODUCTION: Epinephrine and sodium bicarbonate (NaHCO3) used in wide-awake local anesthesia no tourniquet (WALANT) affect many areas such as hemostasis, injection pain, anesthetic effect and others. However, few clinical trials have focused on injection pain and the duration of anesthetic effect, and no prospective studies have reported the benefits of WALANT post operation. This study compared WALANT with conventional local anesthesia with tourniquet in minor hand surgeries, and aimed to answer following questions: (1) Does WALANT have enough benefits for injection pain and duration of anesthetic effect?; (2) How does WALANT affect postoperative management (such as postoperative pain and use of analgesics)?; (3) How satisfied are the patients with the surgery? HYPOTHESIS: We hypothesized that WALANT had advantages in injection pain, duration of anesthetic effect, and postoperative management compared to conventional local anesthesia. MATERIALS AND METHODS: The present study is designed as a randomized prospective one center study. This study included 185 patients who received surgical treatment for the diagnosis of carpal tunnel syndrome, trigger finger, or de Quervain's disease between 2017 and 2019. We randomly allocated the patients to either the WALANT group or the conventional group. We inquired and recorded patients' injection pain, duration of anesthetic effect, postoperative pain, the use of analgesics, and satisfaction with the surgery. RESULTS: The injection pain was significantly lower in the WALANT group in all procedures (p<0.001). The duration of anesthetic effect was significantly longer in the WALANT group in all procedures (p<0.001). As for the postoperative management of all procedures, the pain score was significantly lower in the WALANT group until the first day after surgery, with the biggest difference at 6hours after surgery. The use of analgesics was significantly lower in the WALANT group until the second day after surgery. Satisfaction with surgery was significantly higher in the WALANT group in all procedures: A1 pulley release (p=0.026), 1st extensor retinaculum (p=0.045), and carpal tunnel release (p=0.003). DISCUSSION: Our study showed better results in WALANT than in the conventional method, with no tourniquet pain, lower injection pains, longer anesthetic duration, and less postoperative pain. It provided patients with great satisfaction. In addition, WALANT has the potential benefits of no time limit due to tourniquet pain and long anesthetic effect. Therefore, WALANT is comfortable and cost effective, and could be a good alternative to conventional local lidocaine anesthesia. LEVEL OF EVIDENCE: II. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/32631713/A_randomized_controlled_trial_of_minor_hand_surgeries_comparing_wide_awake_local_anesthesia_no_tourniquet_and_local_anesthesia_with_tourniquet L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0568(20)30132-8 DB - PRIME DP - Unbound Medicine ER -
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