Van Demark Robert E, Becker Hillary A, Anderson Matthew C, Smith Vanessa J S
1 Sanford Orthopedics and Sports Medicine, Sioux Falls, SD, USA.
Hand (N Y). 2018 Jul;13(4):481-485. doi: 10.1177/1558944717715120. Epub 2017 Jun 23.
Wide-awake local anesthesia and no tourniquet (WALANT) has become more popular in hand surgery. Without a tourniquet, there is no need for preoperative testing or sedation. The use of lidocaine with epinephrine has allowed a larger variety of cases to be done safely in an outpatient setting instead of the hospital. "Minor field sterility," which uses fewer drapes and tools to accomplish the same procedures, is a concept that is also gaining recognition.
Investigation of hand surgeons performing a majority of cases using WALANT and minor field sterility was the beginning of seeing its potential at our institution. Administration was concerned about patient safety, cost-effectiveness, and patient satisfaction of the proposed changes. Analysis of our institution to determine location of these procedures was also imperative to using WALANT.
An in-office procedure room was built to allow for WALANT and minor field sterility. The requirements and logistics of developing an in-office procedure room for wide-awake surgery are reviewed in this article.
The concurrent use of WALANT and minor field sterility has created a hand surgery practice that is cost-effective for the patient and the facility and resulted in excellent patient outcomes and satisfaction.
清醒局部麻醉无止血带（WALANT）技术在手部手术中越来越受欢迎。无需止血带，也就无需术前检查或镇静。含肾上腺素的利多卡因的使用使得更多种类的手术能够在门诊而非医院安全进行。“小范围术野无菌技术”使用更少的手术单和工具来完成相同的手术，这一概念也越来越受到认可。
对大多数手术采用WALANT和小范围术野无菌技术的手外科医生进行调查，是我们机构认识到其潜力的开端。管理层关注拟议变革对患者安全、成本效益和患者满意度的影响。分析我们机构以确定这些手术的实施地点对于采用WALANT技术也至关重要。
建造了一间门诊手术室以施行WALANT和小范围术野无菌技术。本文回顾了为清醒手术开发门诊手术室的要求和后勤保障。
同时采用WALANT和小范围术野无菌技术创造了一种手部手术实践模式，对患者和医疗机构而言都具有成本效益，并带来了出色的患者治疗效果和满意度。
