Bashir Muhammad Mustehsan, Qayyum Rehan, Saleem Muhammad Hammad, Siddique Kashif, Khan Farid Ahmad
Plastic Surgery Department, King Edward Medical University, Mayo Hospital Lahore, Lahore, Punjab, Pakistan.
Department of Medicine, University of Tennessee College of Medicine at Chattanooga, Chattanooga, TN.
J Hand Surg Am. 2015 Aug;40(8):1606-9. doi: 10.1016/j.jhsa.2015.03.034. Epub 2015 May 13.
To determine the optimal time interval between tumescent local anesthesia infiltration and the start of hand surgery without a tourniquet for improved operative field visibility.
Patients aged 16 to 60 years who needed contracture release and tendon repair in the hand were enrolled from the outpatient clinic. Patients were randomized to 10-, 15-, or 25-minute intervals between tumescent anesthetic solution infiltration (0.18% lidocaine and 1:221,000 epinephrine) and the start of surgery. The end point of tumescence anesthetic infiltration was pale and firm skin. The surgical team was blinded to the time of anesthetic infiltration. At the completion of the procedure, the surgeon and the first assistant rated the operative field visibility as excellent, fair, or poor. We used logistic regression models without and with adjustment for confounding variables.
Of the 75 patients enrolled in the study, 59 (79%) were males, 7 were randomized to 10-minute time intervals (further randomization was stopped after interim analysis found consistently poor operative field visibility), and 34 were randomized to the each of the 15- and 25-minute groups. Patients who were randomized to the 25-minute delay group had 29 times higher odds of having an excellent operative visual field than those randomized to the 15-minute delay group. After adjusting for age, sex, amount of tumescent solution infiltration, and duration of operation, the odds ratio remained highly significant.
We found that an interval of 25 minutes provides vastly superior operative field visibility; 10-minute delay had the poorest results.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
确定肿胀局部麻醉浸润与无止血带手部手术开始之间的最佳时间间隔，以提高手术视野的清晰度。
从门诊招募16至60岁需要手部挛缩松解和肌腱修复的患者。患者被随机分为肿胀麻醉溶液浸润（0.18%利多卡因和1:221,000肾上腺素）与手术开始之间间隔10分钟、15分钟或25分钟的组。肿胀麻醉浸润的终点是皮肤苍白且坚硬。手术团队对麻醉浸润时间不知情。手术结束时，外科医生和第一助手将手术视野清晰度评为优秀、一般或差。我们使用了未调整和调整混杂变量的逻辑回归模型。
在该研究纳入的75例患者中，59例（79%）为男性，7例被随机分配到10分钟时间间隔组（中期分析发现手术视野清晰度一直很差后停止进一步随机分组），34例被随机分配到15分钟和25分钟组中的每组。被随机分配到25分钟延迟组的患者获得优秀手术视野的几率比被随机分配到15分钟延迟组的患者高29倍。在调整年龄、性别、肿胀溶液浸润量和手术持续时间后，优势比仍然非常显著。
我们发现25分钟的间隔可提供明显更优的手术视野清晰度；10分钟延迟的结果最差。
研究类型/证据水平：治疗性I级。
