Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
School of Medicine, University of Limerick, Ireland.
Hand (N Y). 2024 Jan;19(1):58-67. doi: 10.1177/15589447221109632. Epub 2022 Jul 26.
The purpose of this systematic review was to analyze the available literature on fixation of distal radius fractures (DRFs) under wide-awake local anesthesia no-tourniquet (WALANT), and to examine postoperative pain scores and functional outcomes, operative data including operative time and blood loss, and the frequency of adverse events.
Embase, MEDLINE, Web of Science, and SCOPUS were searched from inception until May 2022 for relevant studies. Studies were screened in duplicate, and data on pain scores, functional outcomes, and adverse events were recorded. Due to methodological and statistical heterogeneity, the results are presented in a descriptive fashion.
Ten studies were included comprising 456 patients with closed, unilateral DRFs, of whom 226 underwent fixation under WALANT. These patients had a mean age of 52.8 ± 8.3 years, were 48% female, and had a mean follow-up time of 11.6 months (range: 6-24). Operative time for WALANT patients averaged 60.4 ± 6.5 minutes, with mean postoperative pain scores of 1.4 ± 0.6 on a 10-point scale. Studies that compared WALANT to general anesthesia found shorter hospital stays with most WALANT patients being sent home the same day, decreased postoperative pain scores, and decreased costs to the healthcare system. No adverse events were reported for WALANT patients.
A growing body of literature reports that for closed, unilateral DRF, surgical fixation under WALANT is a safe and effective option. It allows patients to have surgery sooner, with improved pain scores and good functional outcomes, with a very low incidence of adverse events.
本系统评价的目的是分析在清醒局部麻醉无止血带（WALANT）下治疗桡骨远端骨折（DRF）的现有文献，并研究术后疼痛评分和功能结果、手术数据（包括手术时间和失血量）以及不良事件的发生频率。
从建库起至 2022 年 5 月，在 Embase、MEDLINE、Web of Science 和 SCOPUS 中搜索相关研究。对研究进行重复筛选，并记录疼痛评分、功能结果和不良事件的数据。由于方法学和统计学上的异质性，结果以描述性方式呈现。
纳入了 10 项研究，共包括 456 例闭合性、单侧 DRF 患者，其中 226 例行 WALANT 固定术。这些患者的平均年龄为 52.8±8.3 岁，女性占 48%，平均随访时间为 11.6 个月（范围：6-24）。WALANT 患者的手术时间平均为 60.4±6.5 分钟，术后疼痛评分为 10 分制的 1.4±0.6 分。与全身麻醉相比，WALANT 组的住院时间更短，大多数 WALANT 患者当天即可出院，术后疼痛评分降低，且降低了医疗系统的成本。未报告 WALANT 患者发生不良事件。
越来越多的文献报告称，对于闭合性、单侧 DRF，WALANT 下的手术固定是一种安全有效的选择。它可以让患者更早地接受手术，疼痛评分改善，功能结果良好，不良事件发生率极低。
