Coffman Jason R, Dela Cruz Jeffrey A, Stein Brandon A, Bagg Mark R, Person David W, Desai Kunj K, Srinivasan Ramesh C
The Hand Center of San Antonio, TX, USA.
College of Medicine, University of Florida, Gainesville, USA.
Hand (N Y). 2024 Mar 15:15589447241235251. doi: 10.1177/15589447241235251.
This study examined the complication rate of Wide Awake Local Anesthesia No Tourniquet (WALANT) technique in the clinic setting with field sterility at a single private practice. We hypothesized that WALANT is safe and effective with a low complication rate.
This retrospective chart review included 1228 patients who underwent in-office WALANT hand procedures at a single private practice between 2015 and 2022. Patients were divided into groups based on type of procedure: carpal tunnel release, A1 pulley release, first dorsal compartment release, extensor tendon repair, mass excision, foreign body removal, and needle aponeurotomy. Patient demographics and complications were recorded; statistical comparisons of cohort demographics and risk factors for complications were completed, and < .05 was considered significant for all statistical comparisons.
The overall complication rate for all procedures was 2.77% for 1228 patients including A1 pulley release (n = 962, 2.7%), mass excision (n = 137, 3.7%), extensor tendon repair (n = 23, 4.3%), and first dorsal compartment release (n = 22, 8.3%). Carpal tunnel release, foreign body removal, and needle aponeurotomy groups experienced no complications. No adverse events (e.g. vasovagal reactions, digital ischemia, local anesthetic toxicity, inadequate vasoconstriction) were observed in any group. Patients with known autoimmune disorders and those who were currently smoking had a statistically significant higher complication rate.
Office-based WALANT procedures with field sterility are safe and effective for treating common hand maladies and have a similar complication profile when compared to historical controls from the standard operating room in an ambulatory center or hospital.
本研究在一家私人诊所中，在术野无菌的临床环境下，对清醒局部麻醉无止血带（WALANT）技术的并发症发生率进行了检查。我们假设WALANT安全有效，并发症发生率低。
这项回顾性图表审查纳入了2015年至2022年间在一家私人诊所接受门诊WALANT手部手术的1228例患者。根据手术类型将患者分为不同组：腕管松解术、A1滑车松解术、第一背侧间室松解术、伸肌腱修复术、肿块切除术、异物取出术和针刀切开术。记录患者的人口统计学资料和并发症情况；完成队列人口统计学资料和并发症危险因素的统计学比较，所有统计学比较中P<0.05被认为具有统计学意义。
1228例患者的所有手术总体并发症发生率为2.77%，其中包括A1滑车松解术（n=962，2.7%）、肿块切除术（n=137，3.7%）、伸肌腱修复术（n=23，4.3%）和第一背侧间室松解术（n=22，8.3%）。腕管松解术、异物取出术和针刀切开术组未发生并发症。任何组均未观察到不良事件（如血管迷走神经反应、手指缺血、局部麻醉药毒性、血管收缩不足）。已知患有自身免疫性疾病的患者和目前吸烟的患者并发症发生率在统计学上显著更高。
在术野无菌的情况下，门诊WALANT手术对于治疗常见手部疾病是安全有效的，并且与门诊中心或医院标准手术室的历史对照相比，具有相似的并发症情况。
