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Degreef I, Lalonde DH. WALANT surgery of the hand: state of the art. EFORT Open Rev 2024; 9:349-356. [PMID: 38726975 PMCID: PMC11099575 DOI: 10.1530/eor-24-0033] [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] [Indexed: 05/12/2024] Open
Abstract
Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25-1% lidocaine, with 1:100 000-1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.
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Affiliation(s)
- Ilse Degreef
- Department of Orthopaedic, Hand Unit, Leuven University Hospitals, Gasthuisberg, Herestraat, Leuven, Belgium
| | - Donald H Lalonde
- Division of Plastic Surgery, Dalhousie University, Saint John, New Brunswick, Canada
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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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Castelo F, Santos C, Costa B, Sousa R, Ricardo R, Batista P, Ribeiro D. Wide-Awake Local Anesthesia No Tourniquet for Rhizarthrosis Surgery: Technique and Experience for 16 Consecutive Cases. Cureus 2023; 15:e45705. [PMID: 37876397 PMCID: PMC10591532 DOI: 10.7759/cureus.45705] [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] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Since it was described, wide-awake local anaesthesia no tourniquet (WALANT) has gained popularity. Our department has started using WALANT for hand surgery with increasing complexity. We present our results with WALANT rhizarthrosis surgery, including prosthetic replacement, trapeziectomy with suture button suspensionplasty and revision surgery. A retrospective review of all rhizarthrosis procedures under WALANT was performed from April 2021 to July 2022. We included patients who fulfilled inclusion criteria and had adequate imaging and clinical follow-up. A satisfaction survey was performed by telephone. Surgical time, complications, conversion to conventional anesthesia, pain, anxiety and global satisfaction were recorded. Tumescent anesthesia is performed 20-25 minutes before surgery, and is performed in four or five strategic locations that allow adequate anesthesia and vasoconstriction for the procedure to be comfortably carried out. We observed a series of 16 sequential surgeries involving 14 patients. All were female with a mean age of 65 years. Fourteen cases were performed due to primary rhizarthrosis, eight trapeziectomies with suture button suspensionplasty, six prosthetic replacements, and two revision surgeries. One patient needed to be converted to conventional anaesthesia due to anxiety during the procedure. Mean procedure time was 73 minutes. There were no WALANT-related complications. Mean patient-reported satisfaction with the anesthetic technique was a 9 (on a scale from 1 to 10) and 100% of patients would choose to undergo surgery with WALANT anesthesia for a future procedure. We find it useful to actively engage the patients during surgery to keep them comfortable and also help the surgeons assess stability and functional results. After wound closure, the hand is shown to the patient and he performs various tasks. There is somewhat of a learning curve for rhizarthrosis surgery under WALANT; patient comfort can be achieved through an adequate anesthetic technique and reassurance before and during surgery. We recommend that the first few cases be done in the presence of an anesthesiologist and a fasting patient in case there is a need to convert to conventional anesthesia. Wide awake rhizarthrosis surgery, even revision surgery, is safe and pain-free. Patient-reported satisfaction is also high. The authors find that including patient participation in their own surgery might be promising for post-op rehabilitation. There are limitations in this study such as the absence of a control conventional anesthesia group, the satisfaction questionnaire was not done immediately post-operatively, as such, a memory bias cannot be excluded, and it is not yet validated for the Portuguese population.
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Affiliation(s)
- Filipe Castelo
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
| | - Cláudia Santos
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
| | - Bárbara Costa
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
| | - Ricardo Sousa
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
| | - Raquel Ricardo
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
| | - Pedro Batista
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
| | - Daniel Ribeiro
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
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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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Shahid S, Saghir N, Saghir R, Young-Sing Q, Miranda BH. WALANT: A Discussion of Indications, Impact, and Educational Requirements. Arch Plast Surg 2022; 49:531-537. [PMID: 35919552 PMCID: PMC9340192 DOI: 10.1055/s-0042-1748659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.
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Affiliation(s)
- Shahab Shahid
- The Centre for Hand Surgery, St. Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, United Kingdom
| | - Noman Saghir
- Nightingale Breast Centre, Wythenshawe Hospital, Manchester, United Kingdom
| | - Reyan Saghir
- Department of Cardiology, Calderdale Royal Hospital, Halifax, United Kingdom
| | - Quillan Young-Sing
- The Centre for Hand Surgery, St. Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, United Kingdom
| | - Benjamin H Miranda
- The Centre for Hand Surgery, St. Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, United Kingdom.,St Andrew&s Anglia Ruskin (StAAR) Research Group, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, United Kingdom
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Tuna Z, Ayhan E. Wide-Awake Hand Surgery Experience in Patients 10 to 18 Years of Age. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:389-393. [DOI: 10.1016/j.jhsg.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022] Open
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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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Trapeziometacarpal (TMC) arthroplasty under Wide Awake Local Anesthesia with No Tourniquet (WALANT) versus Local Anesthesia with peripheral nerve blocks (LAPNV): Perioperative pain and early functional results in 30 patients. HAND SURGERY & REHABILITATION 2021; 40:453-457. [PMID: 33775887 DOI: 10.1016/j.hansur.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/25/2021] [Accepted: 03/21/2021] [Indexed: 12/28/2022]
Abstract
We hypothesized that WALANT would provide similar perioperative analgesic comfort compared to local anesthesia with peripheral nerve blocks (LAPNV). We analyzed whether the patient's active participation during surgery would improve its early functional results. We did a retrospective, single study in an outpatient surgery unit, comparing two types of surgery: trapeziometacarpal arthroplasty (TMCA) under LAPNV and TMCA under WALANT. Fifteen patients were included per group. Pain levels were determined during anesthesia induction, intraoperatively, postoperatively, at rest and during activity at the last follow-up visit. The overall satisfaction with the surgery and time to resume daily activities and work were documented. The statistical analysis was performed on SAS software with an ANOVA. The significance threshold was set at 0.05. The groups were comparable on age, sex, dominant side, and operated side. No patients were lost to follow-up. The mean follow-up was 4 months (2.3-11). The QuickDASH score was 4.93 for TMCA under WALANT vs. 13.47 for TMCA under LAPNV (p = 0.01). There was no loosening, dislocation, or major complication. Our study showed that TMCA performed with WALANT yields similar results to the same procedure with LAPNV for perioperative pain relief without additional complications. Functional scores seem to be slightly improved with WALANT compared to LAPNV, but these results should be confirmed with longer follow up.
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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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de Boccard O, Müller C, Christen T. Economic impact of anaesthesia methods used in hand surgery: Global costs and operating room's throughput. J Plast Reconstr Aesthet Surg 2020; 74:2149-2155. [PMID: 33451945 DOI: 10.1016/j.bjps.2020.12.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/23/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Recently, local anaesthesia has become popular among hand surgeons. We hypothesized that using the "wide awake local anaesthesia no tourniquet" (WALANT) approach would result in lower global costs and in an increase in the operating room (OR)'s efficiency. METHODS All cases of carpal tunnel (CTR) and trigger finger releases (TFR) performed over 2016 and 2017 were divided into four groups, following which the anaesthesia method was used. Total OR occupation time, surgical time and the "all but surgery" time were analysed. A common minimum bill per anaesthesia was generated. RESULTS WALANT or local anaesthesia and tourniquet increase the OR's throughput by having shorter operation room occupation times than other methods (17.5-33%). Costs of the two procedures are reduced by 21-31% when using local anaesthesia methods. CONCLUSION Preferring those techniques for CTR and TFR has a notable beneficial impact on the costs and on the OR's efficiency. This effect is more evident on short surgical procedures. LOE: Level of evidence III, economic analysis.
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Affiliation(s)
- Olivier de Boccard
- Centre de la Main, Plastic and Hand surgery Unit, University Hospital of Lausanne (CHUV), Avenue Pierre Decker 4, CH-1005 Lausanne, Switzerland.
| | - Camillo Müller
- Centre de la Main, Plastic and Hand surgery Unit, University Hospital of Lausanne (CHUV), Avenue Pierre Decker 4, CH-1005 Lausanne, Switzerland.
| | - Thierry Christen
- Centre de la Main, Plastic and Hand surgery Unit, University Hospital of Lausanne (CHUV), Avenue Pierre Decker 4, CH-1005 Lausanne, Switzerland.
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Muder D, Hailer NP, Vedung T. Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years. BMC Musculoskelet Disord 2020; 21:657. [PMID: 33028285 PMCID: PMC7542730 DOI: 10.1186/s12891-020-03687-3] [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: 06/05/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Methods We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint. Results The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8). Conclusion In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants. Level of evidence III (Therapeutic).
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Affiliation(s)
- Daniel Muder
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University, Entrance 70, 751 85, Uppsala, Sweden. .,Department of Orthopedics, Falu Lasarett, Lasarettsvägen 10, 791 82, Falun, Sweden.
| | - Nils P Hailer
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University, Entrance 70, 751 85, Uppsala, Sweden
| | - Torbjörn Vedung
- Department of Surgical Sciences/Orthopedics & Hand Surgery, Uppsala University, Entrance 70, 751 85, Uppsala, Sweden.,Elisabeth Hospital, Aleris Healthcare AB, Geijersgatan 20, 752 26, Uppsala, Sweden
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