Division of Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum Rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.
Arch Orthop Trauma Surg. 2021 Mar;141(3):527-533. doi: 10.1007/s00402-020-03744-5. Epub 2021 Jan 23.
Although the WALANT technique's long-term safeness has been demonstrated in many studies, there are only few data investigating its short-term effects on tissue perfusion and oxygen levels. It was hypothesized that, temporarily, critical levels of tissue perfusion may occur.
Seventeen patients, who were scheduled for different procedures in WALANT technique, were injected with 5-7 ml of 1% Articain containing 1:200,000 epinephrine at the finger base. Capillary-venous oxygen saturation, hemoglobin volume in the capillaries, and relative blood flow in the fingertips were recorded once per second by white light spectrometry and laser Doppler flowmetry before, during and after injection for an average of 32 min.
Clinically, no persistent tissue malperfusion was observed, and there were no postoperative complications. Capillary-venous oxygen saturation was reduced by ≥ 30% in seven patients. Critical levels of oxygen saturation were detected in four patients during 13 intervals, each lasting for 132.5 s on average. Oxygen saturation returned to noncritical values in all patients by the end of the observation period. Blood flow in the fingertips was reduced by more than 30% in nine patients, but no critical levels were observed, as with the hemoglobin. Three patients demonstrated a reactive increase in blood flow of more than 30% after injection.
Injection of tumescent local anesthesia containing epinephrine into finger base may temporarily cause a substantial reduction in blood flow and lead to critical levels of oxygen saturation in the fingertips. However, this was fully reversible within minutes and does not cause long-term complications.
尽管 WALANT 技术的长期安全性已在多项研究中得到证实，但仅有少数数据研究其对组织灌注和氧水平的短期影响。研究假设，组织灌注可能会暂时出现临界水平。
17 名患者在 WALANT 技术下接受不同手术，在手指根部注射 5-7ml 含 1:200000 肾上腺素的 1%阿替卡因。通过白光光谱仪和激光多普勒血流仪，在注射前、注射中和注射后，每秒钟记录一次毛细血管-静脉氧饱和度、毛细血管中的血红蛋白体积和指尖的相对血流，平均持续 32 分钟。
临床上，未观察到持续的组织灌注不良，也没有术后并发症。7 名患者的毛细血管-静脉氧饱和度降低了≥30%。在 13 个间隔中，有 4 名患者的氧饱和度降至临界水平，平均每个间隔持续 132.5 秒。在观察期结束时，所有患者的氧饱和度均恢复到非临界值。9 名患者指尖血流减少超过 30%，但未观察到临界水平，血红蛋白也是如此。注射后，3 名患者的血流出现超过 30%的反应性增加。
在手指根部注射含肾上腺素的肿胀局部麻醉可能会暂时导致血流量显著减少，并导致指尖的氧饱和度降至临界水平。然而，这在数分钟内完全可逆，不会导致长期并发症。
