Farooq Rahy, Raufi Muhammad Yasir, Soe Bryan, Suleman Amir-Humza, Seraj Shaikh Sanjid, Arif Abida, Rahman Shafiq, Bhat Waseem
Core Surgical Trainee, Leeds Teaching Hospitals, Leeds, United Kingdom.
Junior Clinical Fellow, Leeds General Infirmary, Leeds, United Kingdom.
J Hand Microsurg. 2024 Sep 13;16(5):100157. doi: 10.1016/j.jham.2024.100157. eCollection 2024 Dec.
Wide awake local anaesthesia no tourniquet (WALANT) surgery has gained increasing popularity in recent years for hand surgery fast-tracked by the COVID pandemic. It involves infiltration of lidocaine with adrenaline to the operative region ensuring a good visual field owing to the vasoconstrictive effects of epinephrine. It has numerous advantages over traditional anaesthetic (TA) for flexor tendon repairs including testing of tendon strength on table as well as immediate revision of the repair if needed. Currently there are a number of studies in the literature evaluating WALANT versus TA in flexor tendon injuries with continuing debate on the optimal modality but no amalgamated synthesis of data. The authors report the first systematic review and meta-analysis on the topic. The authors conducted the review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA) guidelines. All studies comparing flexor tendon repairs under WALANT versus TA were included. The primary outcome measure was range of movement (ROM) with secondary outcomes including adhesions/tenolysis, rupture as well as re-operation rates. OpenMeta[Analyst] software was utilised for data synthesis. Five studies in total met the inclusion criteria with an overall assessment of 624 fingers. There was no significant difference observed between WALANT and TA for tendon rupture; odds ratio 1.027 (0.450, 2.342) p-value = 0.950, the incidence of adhesions/tenolysis; odds ratio 0.601 (0.172, 2.093) p-value = 0.424 or re-operation rates; odds ratio 1.193 (0.544, 2.618) p-value = 0.659. ROM was reported to be better in the WALANT cohort; odds ratio: 1.641 (1.010, 2.669) p-value = 0.046. WALANT offers a safe and effective mode of anaesthetic over traditional modalities with comparable outcomes for flexor tendon repairs. Although ROM appears superior, the number of randomised control trials are currently low and more high quality studies are necessitated to enhance the current evidence base.
近年来，清醒局部麻醉无止血带（WALANT）手术在因新冠疫情而加速的手部手术中越来越受欢迎。它包括将利多卡因与肾上腺素注入手术区域，由于肾上腺素的血管收缩作用，可确保良好的视野。与传统麻醉（TA）相比，它在屈肌腱修复方面有许多优势，包括在手术台上测试肌腱强度，以及在需要时立即对修复进行修正。目前，文献中有多项研究评估WALANT与TA在屈肌腱损伤中的应用，关于最佳方式的争论仍在继续，但尚未对数据进行综合分析。作者报告了该主题的首次系统评价和荟萃分析。作者按照系统评价和荟萃分析的首选报告项目声明标准（PRISMA）指南进行了该评价。纳入了所有比较WALANT与TA下屈肌腱修复的研究。主要结局指标是活动范围（ROM），次要结局包括粘连/肌腱松解、断裂以及再次手术率。使用OpenMeta[Analyst]软件进行数据合成。共有五项研究符合纳入标准，共评估了624根手指。在肌腱断裂方面，WALANT和TA之间未观察到显著差异；优势比为1.027（0.450，2.342），p值 = 0.950；粘连/肌腱松解的发生率；优势比为0.601（0.172，2.093），p值 = 0.424；再次手术率；优势比为1.193（0.544，2.618），p值 = 0.659。据报道，WALANT组中的ROM更好；优势比：1.641（1.010, 2.669），p值 = 0.046。与传统方式相比，WALANT提供了一种安全有效的麻醉方式，在屈肌腱修复方面有可比的结果。尽管ROM似乎更优，但目前随机对照试验的数量较少，需要更多高质量的研究来加强当前的证据基础。
