Folberg Celso Ricardo, Alves Jairo André de Oliveira, Pereira Fernando Maurente Sirena, Rabuske William Bernardo Specht
Department of Orthopedics, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
J Hand Surg Glob Online. 2023 Jan 21;5(2):201-205. doi: 10.1016/j.jhsg.2022.12.006. eCollection 2023 Mar.
The wide-awake local anesthesia no tourniquet technique has been widely performed in hand and wrist surgery with remarkable results. However, its use on the elbow has rarely been reported. Here we describe the use of wide-awake local anesthesia no tourniquet in olecranon fracture fixation in 4 cases.
Tumescent anesthesia was injected from the proximal ulna to approximately 10 cm distally and into the periosteum and fracture site, approximately 25 minutes before skin incision. The fracture underwent closed reduction and was fixed using a long 6.5-mm cancellous screw with a washer through a small incision. No tourniquet was applied and none or mild sedation was administered. At the end of the operation, patients were asked to perform active elbow flexion-extension and forearm pronosupination movements under an image intensifier to test the range of motion and fracture stability.
The surgical procedure was completed in all 4 cases. Two patients reported mild pain during ulnar medullary canal reaming, with pain scores of 3 and 4 on a 10-point scale, respectively. One case was resolved with additional local anesthetic injection. The other case required the administration of intravenous propofol. Both patients were able to actively move the elbow at the end of the operation.
The use of wide-awake local anesthesia no tourniquet for olecranon fracture fixation has the advantage of obviating the need for an arm tourniquet, general anesthesia or heavy sedation, preoperative tests, and discontinuing routine medications (including anticoagulants). The stability of the elbow fixation was tested by active motion during surgery. This simple, safe, low-cost, and reproducible technique may be a good option for patients with contraindications or high risk of general or regional nerve block anesthesia.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
清醒局部麻醉无止血带技术已在手和腕部手术中广泛应用，效果显著。然而，其在肘部的应用鲜有报道。在此，我们描述4例鹰嘴骨折固定术中清醒局部麻醉无止血带技术的应用。
在皮肤切开前约25分钟，从尺骨近端向远端约10厘米处注射肿胀麻醉剂，并注入骨膜和骨折部位。骨折进行闭合复位，通过一个小切口使用一枚带垫圈的6.5毫米长的松质骨螺钉进行固定。未使用止血带，未给予或仅给予轻度镇静。手术结束时，要求患者在影像增强器下进行主动的肘关节屈伸和前臂旋前旋后运动，以测试活动范围和骨折稳定性。
4例手术均顺利完成。2例患者在尺骨髓腔扩髓时报告轻度疼痛，疼痛评分在10分制中分别为3分和4分。1例通过额外注射局部麻醉剂解决。另1例需要静脉注射丙泊酚。两名患者在手术结束时均能主动活动肘关节。
清醒局部麻醉无止血带用于鹰嘴骨折固定具有无需使用手臂止血带、全身麻醉或深度镇静、术前检查以及停用常规药物（包括抗凝剂）的优点。术中通过主动活动测试肘关节固定的稳定性。这种简单、安全、低成本且可重复的技术对于有全身或区域神经阻滞麻醉禁忌证或高风险的患者可能是一个不错的选择。
研究类型/证据水平：治疗性IV级。
