腕管综合征的 WALANT 与静脉内局部麻醉：一项随机临床试验。
WALANT versus intravenous regional anesthesia for carpal tunnel syndrome: a randomized clinical trial.
机构信息
MD. Doctoral Student and Hand Surgeon, Discipline of Hand and Upper Limb Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Hand Surgeon, Hand Surgery Service, Hospital Alvorada Moema, United Health, São Paulo (SP), Brazil.
MD, PhD. Hand Surgeon, Discipline of Hand and Upper Limb Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Hand Surgeon, Hand Surgery Service, Hospital Alvorada Moema, United Health, São Paulo (SP), Brazil.
出版信息
Sao Paulo Med J. 2021 Oct 11;139(6):576-578. doi: 10.1590/1516-3180.2020.0583.R2.0904221. eCollection 2021.
BACKGROUND
There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the "wide awake local anesthesia no tourniquet" (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques.
OBJECTIVE
To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier's block), for surgical treatment of CTS.
DESIGN AND SETTING
Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
METHODS
Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications.
RESULTS
The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06).
CONCLUSIONS
The WALANT technique is more effective than IVRA for CTS surgery.
背景
腕管综合征（CTS）的手术治疗有几种麻醉技术。已经描述了使用“清醒局部麻醉无止血带”（WALANT）技术进行这种手术的结果。然而，与常规技术相比，WALANT 技术的有效性尚无确凿证据。
目的
评估 WALANT 技术与静脉内区域麻醉（IVRA；Bier 阻滞）相比，在 CTS 手术治疗中的效果。
设计和设置
在巴西圣保罗联邦大学（UNIFESP）莫梅亚阿尔沃拉达医院和手外科学科进行的随机临床试验。
方法
纳入了 78 名患者。主要结局是通过视觉模拟评分（VAS）测量围手术期疼痛。次要结局是波士顿问卷评分、医院焦虑和抑郁量表（HADS）评分、使用镇痛药的需求、手术室时间、感觉异常缓解、失败和并发症。
结果
WALANT 技术（n = 40）优于 IVRA（n = 38），尤其是在控制术中疼痛（0.11 对 3.7cm；P < 0.001）和术后疼痛（0.6 对 3.9cm；P < 0.001）方面。IVRA 组患者在手术室中花费的时间更长（59.5 对 46 分钟；P < 0.01），需要使用更多的镇痛药（10.8 对 5.7 片扑热息痛；P = 0.02）。有 5 例 IVRA 手术失败（5 对 0；P = 0.06）。
结论
WALANT 技术在 CTS 手术中比 IVRA 更有效。
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