Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
Orthop Traumatol Surg Res. 2020 Dec;106(8):1645-1651. doi: 10.1016/j.otsr.2020.03.013. Epub 2020 Jul 4.
Epinephrine and sodium bicarbonate (NaHCO) used in wide-awake local anesthesia no tourniquet (WALANT) affect many areas such as hemostasis, injection pain, anesthetic effect and others. However, few clinical trials have focused on injection pain and the duration of anesthetic effect, and no prospective studies have reported the benefits of WALANT post operation. This study compared WALANT with conventional local anesthesia with tourniquet in minor hand surgeries, and aimed to answer following questions: (1) Does WALANT have enough benefits for injection pain and duration of anesthetic effect?; (2) How does WALANT affect postoperative management (such as postoperative pain and use of analgesics)?; (3) How satisfied are the patients with the surgery?
We hypothesized that WALANT had advantages in injection pain, duration of anesthetic effect, and postoperative management compared to conventional local anesthesia.
The present study is designed as a randomized prospective one center study. This study included 185 patients who received surgical treatment for the diagnosis of carpal tunnel syndrome, trigger finger, or de Quervain's disease between 2017 and 2019. We randomly allocated the patients to either the WALANT group or the conventional group. We inquired and recorded patients' injection pain, duration of anesthetic effect, postoperative pain, the use of analgesics, and satisfaction with the surgery.
The injection pain was significantly lower in the WALANT group in all procedures (p<0.001). The duration of anesthetic effect was significantly longer in the WALANT group in all procedures (p<0.001). As for the postoperative management of all procedures, the pain score was significantly lower in the WALANT group until the first day after surgery, with the biggest difference at 6hours after surgery. The use of analgesics was significantly lower in the WALANT group until the second day after surgery. Satisfaction with surgery was significantly higher in the WALANT group in all procedures: A1 pulley release (p=0.026), 1st extensor retinaculum (p=0.045), and carpal tunnel release (p=0.003).
Our study showed better results in WALANT than in the conventional method, with no tourniquet pain, lower injection pains, longer anesthetic duration, and less postoperative pain. It provided patients with great satisfaction. In addition, WALANT has the potential benefits of no time limit due to tourniquet pain and long anesthetic effect. Therefore, WALANT is comfortable and cost effective, and could be a good alternative to conventional local lidocaine anesthesia.
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在清醒局部麻醉无止血带（WALANT）中使用肾上腺素和碳酸氢钠（NaHCO）会影响止血、注射疼痛、麻醉效果等许多方面。然而，很少有临床试验关注注射疼痛和麻醉效果的持续时间，也没有前瞻性研究报告 WALANT 术后的益处。本研究比较了 WALANT 与传统带止血带的局部麻醉在手部小手术中的效果，旨在回答以下问题：（1）WALANT 在注射疼痛和麻醉效果持续时间方面是否有足够的优势？；（2）WALANT 如何影响术后管理（如术后疼痛和使用止痛药）？；（3）患者对手术的满意度如何？
我们假设 WALANT 在注射疼痛、麻醉效果持续时间和术后管理方面优于传统局部麻醉。
本研究设计为一项随机前瞻性单中心研究。这项研究纳入了 2017 年至 2019 年间接受手术治疗的腕管综合征、扳机指或 De Quervain 病的 185 名患者。我们将患者随机分配到 WALANT 组或常规组。我们询问并记录了患者的注射疼痛、麻醉效果持续时间、术后疼痛、止痛药使用情况以及对手术的满意度。
在所有手术中，WALANT 组的注射疼痛明显低于常规组（p<0.001）。在所有手术中，WALANT 组的麻醉效果持续时间明显长于常规组（p<0.001）。在所有手术的术后管理中，WALANT 组的疼痛评分在术后第一天明显较低，术后 6 小时的差异最大。WALANT 组在术后第二天前止痛药的使用明显较低。在所有手术中，WALANT 组对手术的满意度明显较高：A1 滑车释放（p=0.026）、1 号伸肌支持带（p=0.045）和腕管松解术（p=0.003）。
我们的研究表明，WALANT 比传统方法效果更好，无止血带疼痛、注射疼痛更低、麻醉持续时间更长、术后疼痛更少。它为患者提供了极大的满意度。此外，WALANT 由于止血带疼痛和麻醉效果持续时间长，具有无时间限制的潜在优势。因此，WALANT 舒适且具有成本效益，是传统局部利多卡因麻醉的良好替代方案。
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