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Chua M, Ratnagandhi A, Seth I, Lim B, Cevik J, Rozen WM. The Evidence for Perioperative Anesthetic Techniques in the Prevention of New-Onset or Recurrent Complex Regional Pain Syndrome in Hand Surgery. J Pers Med 2024; 14:825. [PMID: 39202016 PMCID: PMC11355343 DOI: 10.3390/jpm14080825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 09/03/2024] Open
Abstract
Complex regional pain syndrome (CRPS) is a multifaceted condition characterized by chronic neuropathic pain, allodynia, and hyperalgesia. The incidence of CRPS postoperatively is alarmingly high, particularly following carpal tunnel surgeries, Dupuytren's fasciectomy, and repairs of wrist and hand fractures, with recurrence rates soaring in individuals with a history of CRPS. Despite extensive research, the management of CRPS remains complicated, highlighting the urgent need for effective prevention strategies. This scoping review aimed to consolidate current evidence surrounding the efficacy of perioperative anesthetic techniques in preventing new-onset or recurrent CRPS, focusing on the application of various anesthetic interventions. Through a comprehensive literature search, eight articles were identified, discussing a spectrum of techniques, including wide awake local anesthesia no tourniquet (WALANT) and various regional blockade methods. This review revealed that the WALANT technique, with its simplicity and lower costs, exhibited promising results in preventing CRPS. Conversely, techniques involving intravenous regional and axillary plexus blocks showed variable efficacy, necessitating further investigation. The scarcity of high-quality evidence underscores the critical need for meticulously designed, large-scale randomized controlled trials to validate these findings and explore the potential of stellate ganglion block in the prevention of recurrent CRPS.
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Affiliation(s)
- Marcel Chua
- Department of Surgery, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; (A.R.); (I.S.); (B.L.); (J.C.); (W.M.R.)
- Department of Plastic and Reconstructive Surgery, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
- Monash Doctors Workforce, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Avinassh Ratnagandhi
- Department of Surgery, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; (A.R.); (I.S.); (B.L.); (J.C.); (W.M.R.)
- Department of Plastic and Reconstructive Surgery, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Ishith Seth
- Department of Surgery, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; (A.R.); (I.S.); (B.L.); (J.C.); (W.M.R.)
- Department of Plastic and Reconstructive Surgery, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Bryan Lim
- Department of Surgery, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; (A.R.); (I.S.); (B.L.); (J.C.); (W.M.R.)
- Department of Plastic and Reconstructive Surgery, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
- Department of Plastic and Reconstructive Surgery, Western Health, 160 Gordon Street, Footscray, VIC 3011, Australia
| | - Jevan Cevik
- Department of Surgery, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; (A.R.); (I.S.); (B.L.); (J.C.); (W.M.R.)
- Department of Plastic and Reconstructive Surgery, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Warren M. Rozen
- Department of Surgery, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; (A.R.); (I.S.); (B.L.); (J.C.); (W.M.R.)
- Department of Plastic and Reconstructive Surgery, Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
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Jerome JTJ, C. PK. Chronic proximal ulnar collateral ligament injuries thumb-a case report. J Clin Orthop Trauma 2023; 46:102283. [PMID: 38059054 PMCID: PMC10696455 DOI: 10.1016/j.jcot.2023.102283] [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: 07/31/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
A 55-year-old woman presented with multiple episodes of falls that injured her right thumb and restricted her daily activities because of pain and instability. Ultrasound found the rare proximal metacarpal UCL avulsion. The repair was done using suture anchors under wide-awake anaesthesia with no tourniquet (WALANT). The patient regained her thumb movements, got a stable MCP joint, and remained symptom-free at one year of follow-up. Proximal avulsion of the UCL is rare. Ultrasound confirms the avulsion, and surgical reconstruction under wide-awake anaesthesia allows the surgeon and the patient to assess and appreciate the MCP joint stability, thereby efficiently rehabilitating the patient. The functional outcome of proximal UCL repair is good. This report describes a rare presentation of the proximal metacarpal attachment avulsion injury of the ulnar collateral ligament (UCL) in a thumb and reviews the management.
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Affiliation(s)
| | - Palani Kumar C.
- Olympia Hospital & Research Centre, Trichy, Tamilnadu, India
- Spine Endoscopy and Ortho Clinic, Erode, Tamilnadu, India
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