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Sawhney A, Thacoor A, Nagra R, Geoghegan L, Akhavani M. Wide Awake Local Anesthetic No Tourniquet in Hand and Wrist Surgery: Current Concepts, Indications, and Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5526. [PMID: 38260757 PMCID: PMC10803042 DOI: 10.1097/gox.0000000000005526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/01/2023] [Indexed: 01/24/2024]
Abstract
Background Traditionally, the use of a pneumatic arterial tourniquet was requisite for safe and effective surgery of the hand. The use of arterial tourniquets necessitates the use of regional or general anaesthesia. Wide-awake local anaesthetic no tourniquet (WALANT) has emerged as a novel technique to overcome the limitations of tourniquet use in conjunction with regional/general anaesthesia. This review aimed to examine the safety and effectiveness of WALANT and provide guidance for surgeons with limited WALANT experience. Methods A literature review of MEDLINE was performed up to March 2021 to identify all articles related to the use of WALANT in hand surgery. Any article reporting original data related to the use of WALANT was eligible for inclusion. Results A total of 101 articles were identified through database searching. Of these, 79 met full inclusion criteria and described the use of WALANT in 19 elective and trauma procedures. Current data suggest that WALANT is safe and effective for use in a range of procedures. Conclusions WALANT surgery is increasing in popularity as evidenced by the variety of surgical indications reported in the literature. There is limited comparative data on the cost-effectiveness of WALANT compared to conventional methods. Current data suggest that WALANT is safe, better tolerated by patients and associated with direct and indirect cost savings.
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Affiliation(s)
- Akshat Sawhney
- From the Department of Plastic, Reconstructive and Burns Surgery, Stoke-Mandeville Hospital, Aylesbury, United Kingdom
| | - Amitabh Thacoor
- Department of Plastic and Reconstructive Surgery, St Georges Hospital, London, United Kingdom
| | - Raveenjot Nagra
- University College London, Division of Surgery and Interventional Science, London, United Kingdom
| | - Luke Geoghegan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Mo Akhavani
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
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2
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Meng F, Baradaran A, Jaberi MM, Tran DQH, Finlayson R, Luc M, Xu L, Thibaudeau S. Patient-Reported Quality of Recovery after Local Anesthesia versus Brachial Plexus Block in Hand Surgery: A Randomized Controlled Study. Plast Reconstr Surg 2023; 152:1287-1296. [PMID: 37189224 DOI: 10.1097/prs.0000000000010688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Both local anesthesia (LA) and brachial plexus (BP) anesthesia are commonly used in hand surgery. LA has increased efficiency and reduced costs, but BP is often favored for more complex hand surgery, despite requiring greater time and resources. The primary objective of this study was to assess the quality of recovery of patients who received LA or BP block for hand surgery. Secondary objectives were to compare postoperative pain and opioid use. METHODS This randomized, controlled, noninferiority study enrolled patients undergoing surgery distal to the carpal bones. Patients were randomized to either LA (wrist or digital block) or BP block (infraclavicular block) before surgery. Patients completed the Quality of Recovery-15 questionnaire on postoperative day (POD) 1. Pain level was assessed with a numeric pain rating scale, and narcotic consumption was recorded on POD1 and POD3. RESULTS A total of 76 patients completed the study (LA, n = 46, BP, n = 30). No statistically significant difference was found for median Quality of Recovery-15 score between LA [127.5 (interquartile range, 28)] and BP block [123.5 (interquartile range, 31)]. The inferiority margin of LA to BP block at the 95% confidence interval was less than the minimal clinically important difference of 8, demonstrating noninferiority of LA compared with BP block. There was no statistically significant difference between LA and BP block for numeric pain rating scale scores or narcotic consumption on POD1 and POD3 ( P > 0.05). CONCLUSION LA is noninferior to BP block for hand surgery with regard to patient-reported quality of recovery, postoperative pain, and narcotic use. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Fanyi Meng
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Aslan Baradaran
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Mehrad Mojtahed Jaberi
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - De Q H Tran
- Department of Anesthesiology, McGill University
| | | | - Mario Luc
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Liqin Xu
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Stephanie Thibaudeau
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
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3
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Morris MT, Rolf E, Tarkunde YR, Dy CJ, Wall LB. Patient Concerns About Wide-Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery. J Hand Surg Am 2022; 47:1226.e1-1226.e13. [PMID: 34774346 DOI: 10.1016/j.jhsa.2021.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Wide-Awake Local Anesthetic No Tourniquet (WALANT) hand surgery avoids many medical risks associated with traditional anesthesia options. However, patients may be hesitant to choose the WALANT approach because of concerns about being awake during surgery. The purpose of this study was to characterize patients' thoughts and concerns about being awake during hand surgery and determine factors that may affect their decision about anesthesia options. METHODS Qualitative interviews were conducted with 15 patients with a diagnosis of carpal tunnel syndrome, trigger finger, or De Quervain's tenosynovitis who were receiving nonoperative care. Interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was used to identify themes, concerns, and potential intervention targets. RESULTS Eight participants reported that patients have a general bias against being "knocked out," 7 of whom described concerns of uncertainty about emerging from anesthesia. All participants would consider WALANT, with some reservations. Recurrent themes included ensuring they would not feel, see, or hear the surgery and a preference toward distractions, such as music or engaging conversation. Of 15 participants, 13 would not want to see the surgery. For patients who found WALANT appealing, they valued the decreased time investment compared to sedation and the avoidance of side effects or exacerbation of comorbidities. A recurring theme of trust between surgeon and patient arose when deciding about anesthesia type. CONCLUSIONS Most patients are open to WALANT, but have concerns of hearing the surgery or feeling pain. Potential interventions to address these concerns, beyond establishing a trusting physician-patient relationship, include music or video with headphones and confirming skin numbness prior to surgery. CLINICAL RELEVANCE This study provides insights into patients' thought processes regarding WALANT hand surgery and give the surgeon talking points when counseling patients on their anesthesia type for hand surgery.
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Affiliation(s)
- Marie T Morris
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Elizabeth Rolf
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Yash R Tarkunde
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
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Lalonde D, Ayhan E, Ahmad AA, Koehler S. Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity. J Hand Surg Eur Vol 2022; 47:24-30. [PMID: 34256616 DOI: 10.1177/17531934211029543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hand surgery is rapidly changing. The wide-awake approach, minimum dissection surgery and early protected movement have changed many things. This is an update of some of the important changes regarding early protected movement with K-wired finger fracture management, simplification of nerve decompression surgery, such as elbow median and ulnar nerve releases, and some new areas in performing surgery with wide-awake local anaesthesia without tourniquet.
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Affiliation(s)
- Donald Lalonde
- Plastic Surgery, Dalhousie University, Saint John, NB, Canada
| | - Egemen Ayhan
- Orthopaedics and Traumatology, University of Health Sciences Turkey, Ankara, Turkey
| | - Amir Adham Ahmad
- Department of Orthopaedics, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Steven Koehler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Brooklyn, NY, USA
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Lin YC, Chen WC, Chen CY, Kuo SM. Plate osteosynthesis of single metacarpal fracture: WALANT technique is a cost-effective approach to reduce postoperative pain and discomfort in contrast to general anesthesia and wrist block. BMC Surg 2021; 21:358. [PMID: 34627230 PMCID: PMC8501709 DOI: 10.1186/s12893-021-01362-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures. METHODS We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment. RESULTS A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery. CONCLUSIONS The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.
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Affiliation(s)
- Yen-Chang Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan
| | - Wei-Chieh Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan
| | - Chun-Yu Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung City, Taiwan. .,Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan. .,Department of Biomedical Engineering, I-Shou University, Kaohsiung City, Taiwan.
| | - Shyh-Ming Kuo
- Department of Biomedical Engineering, I-Shou University, Kaohsiung City, Taiwan
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Hoyle AC, Talwalkar SC, Raj Murali S. Bare bones: Fundamentals of diagnostic wrist arthroscopy. J Clin Orthop Trauma 2021; 20:101478. [PMID: 34211833 PMCID: PMC8237361 DOI: 10.1016/j.jcot.2021.101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022] Open
Abstract
Diagnostic wrist arthroscopy is an essential component of the modern orthopaedic wrist surgeon's skill set. Fundamental elements of diagnostic wrist arthroscopy include pre-operative planning and consent, operative set up, surface anatomy, a systematic approach and applied clinical anatomy, and closure. These fundamentals are described, including options and preferences for implementation. A sound understanding of these elements is key to lay the foundations for successful clinical procedures.
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Affiliation(s)
- Antonia C. Hoyle
- Wrightington Upper Limb Unit, Hall Lane Appley Bridge, Wigan, UK
| | | | - S. Raj Murali
- Wrightington Upper Limb Unit, Hall Lane Appley Bridge, Wigan, UK
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Spindler N, Langer S, Heister S. [Implementation of the wide awake local anesthesia no tourniquet (WALANT) type of anesthesia in hand surgery]. DER ORTHOPADE 2021; 50:415-424. [PMID: 33847790 DOI: 10.1007/s00132-021-04098-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/14/2022]
Abstract
Wide awake local anesthesia no tourniquet (WALANT) refers to an anesthesia technique with low bleeding and complication rates, which enables interventions on the hand in an awake patient without the use of a tourniquet. Bleeding control is achieved through addition of vasoconstrictors to the infiltration solution. Since the motor function of the extremity is not affected, it offers the additional possibility of intraoperative active function testing. The WALANT procedure constitutes an established, effective, easily learnt and resource-sparing technique. The spectrum of surgical possibilities with WALANT is wide and covers nearly all elective and many emergency procedures. Due to multiple advantages in contrast to other regional and general anesthesia procedures, WALANT features an increasing spectrum of surgical applications and practitioners. It is therefore of interest for hand surgeons working both in hospitals and private practices.
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Affiliation(s)
- Nick Spindler
- Bereich für Plastische, Ästhetische und Spezielle Handchirurgie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland.
| | - Stefan Langer
- Bereich für Plastische, Ästhetische und Spezielle Handchirurgie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland
| | - Simon Heister
- Bereich für Plastische, Ästhetische und Spezielle Handchirurgie, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland
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8
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Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake Local Anesthesia with No Tourniquet: An Updated Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3507. [PMID: 33786267 PMCID: PMC7997095 DOI: 10.1097/gox.0000000000003507] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT. METHODS A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety. RESULTS The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates. CONCLUSIONS The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.
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Affiliation(s)
- Joey S. Kurtzman
- From the Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, N.Y
| | - Jennifer I. Etcheson
- From the Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, N.Y
| | - Steven M. Koehler
- From the Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, N.Y
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Larsen LP, Hansen TB. Total trapeziometacarpal joint arthroplasty using wide awake local anaesthetic no tourniquet. J Hand Surg Eur Vol 2021; 46:125-130. [PMID: 32567465 DOI: 10.1177/1753193420932465] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We conducted a descriptive study of 50 consecutive cases of total trapeziometacarpal joint arthroplasty by one surgeon using wide awake local anaesthetic no tourniquet to assess the usefulness and reliability of the anaesthesia, any adverse effects and patient acceptance. No difference was found when comparing the duration of surgery with 50 cases of total trapeziometacarpal joint arthroplasty inserted in a bloodless field under general or regional anaesthesia by the same surgeon. Wide awake local anaesthetic no tourniquet was found to be useful in providing adequate anaesthesia and haemostasis, and to be reliable and safe with no adverse effects. Patient satisfaction was high with 100% willing to repeat. Overall, wide awake local anaesthetic no tourniquet was a satisfactory method of anaesthesia for trapeziometacarpal joint arthroplasty with the potential for significant benefits to both patient and surgeon compared with traditional general anaesthesia and regional block.Level of evidence: II.
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Affiliation(s)
- Lotte P Larsen
- Department of Orthopaedics, University Clinic, Holstebro, Denmark
| | - Torben B Hansen
- Department of Orthopaedics, University Clinic, Holstebro, Denmark
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Yin YB, Liu B, Zhu J, Chen SL. Clinical and Epidemiological Features Among Patients with Wrist Arthroscopy Surgery: A Hospital-based Study in China. Orthop Surg 2020; 12:1223-1229. [PMID: 32725748 PMCID: PMC7454219 DOI: 10.1111/os.12746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/03/2020] [Accepted: 06/07/2020] [Indexed: 11/30/2022] Open
Abstract
Propose To analyze the clinical and epidemiological features of patients who underwent wrist arthroscopy procedures. Methods This is a cross‐sectional epidemiological study. The study included a cohort of patients who underwent wrist arthroscopy procedures in a national orthopaedic referral center from 1 February, 2014 to 1 February, 2019. The medical records, diagnosis, and every wrist arthroscopy procedure of all the patients were collected and reviewed. The epidemiological features, detail of the diagnoses, and the procedures of all the patients were systemically analyzed. All the patients were divided into two groups: trauma and non‐trauma conditions. The complexity of the wrist arthroscopy procedure was classified into simple procedures (exploration or debridement) and complex procedures (repair or reconstruction). χ2 test was used to compare proportions between the procedures of different complexity and the two groups of patients. Results A total of 533 patients (332 males and 201 females) were included in this study. More than half (56%) of the patients were in the age group 21–40 and nearly two thirds (62%) of all the 533 patients were male. The diagnoses of all the patients could be classified into eight categories: (i) TFCC injury; (ii) ulnar impactions syndrome; (iii) carpal trauma (carpal bone fractures and/or carpal ligament injures); (iv) distal radius fractures; (v) carpal bone cyst or necrosis; (vi) ganglion cyst; (vii) wrist arthritis; and (viii) disorders of small joint of the hand. The most common conditions treated with wrist arthroscopy were TFCC injury (172 cases), followed by carpal trauma (125 cases) and ulnar impaction syndrome (84 cases). The simple arthroscopic procedures (exploration or debridement) account for 53% of all the procedures while complex reparative or reconstructive procedures account for 47%. There was a significant difference in the proportion between simple procedures and complex procedures in both trauma and non‐traumatic patients. Repair or reconstruction procedures were more frequently performed for wrist trauma patients, whereas exploration or debridement procedures were more frequently performed for non‐trauma patients. Conclusions The largest group of patients who underwent wrist arthroscopy surgery are those who complained of ulnar‐sided wrist pain and the commonly conducted wrist arthroscopy procedures have evolved from simple exploration/debridement to the more complex repair or reconstruction procedures in China.
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Affiliation(s)
- Yao-Bin Yin
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Jing Zhu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Shan-Lin Chen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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Yen CY, Ma CH, Wu CH, Yang SC, Jou IM, Tu YK. A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia. BMC Musculoskelet Disord 2020; 21:459. [PMID: 32660448 PMCID: PMC7359493 DOI: 10.1186/s12891-020-03482-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Arthroscopic excision has currently become popular for the treatment of wrist ganglions. The objective of this study was to evaluate the clinical outcomes and cost effectiveness of arthroscopic wrist ganglion excisions under Wide-Awake Local Anaesthesia No Tourniquet versus general anaesthesia. Methods We retrospectively reviewed patients who underwent arthroscopic ganglionectomy from April 2009 to October 2016 at our institute. They were separated into two groups according to anaesthesia techniques: general anaesthesia and Wide-Awake Local Anaesthesia No Tourniquet. We compared the clinical outcomes and cost-effectiveness of the two groups. Results Seventy-four patients were included. Both groups were matched with regard to the demographics and preoperative clinical assessments. We found no significant differences between groups in postoperative visual analog scale, modified Mayo wrist score, Disabilities of Arm, Shoulder and Hand score, recurrence, residual pain, or complications. Recurrence was found in five of 74 patients, one (4.3%) in the Wide-Awake Local Anaesthesia No Tourniquet group and four (7.8%) in the general anaesthesia group. One extensor tendon injury and four extensor tenosynovitis cases occurred in the general anaesthesia group. Regarding cost effectiveness, the mean operating time in the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were 88.7 ± 24.51 and 121.5 ± 25.75 min, respectively (p < 0.001). The average total costs of the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were €487.4 ± 89.15 and €878.7 ± 182.13, respectively (p < 0.001). Conclusions For arthroscopic wrist ganglion resections, both anaesthesia techniques were effective and safe regarding recurrence rates, complications, and residual pain. The most important finding of this study was that arthroscopic ganglionectomy under Wide-Awake Local Anaesthesia No Tourniquet was superior to that under general anaesthesia for cost-effectiveness. Level of evidence Level III, Retrospective comparative study.
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Affiliation(s)
- Cheng-Yo Yen
- Department of Orthopedics, E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - Ching-Hou Ma
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - Chin-Hsien Wu
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan. .,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.
| | - Shih-Chieh Yang
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - I-Ming Jou
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - Yuan-Kun Tu
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
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