Delgado Facundo, Príncipe Francisco, Alfie Verónica Andrea, Abrego Mariano Oscar, Holc Fernando, Bronenberg Victoria Pedro, Boretto Jorge Guillermo, Rellan Ignacio
Department of Orthopedics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Institute for Clinical Effectiveness and Health Policy, Argentina.
J Hand Microsurg. 2025 Jan 6;17(2):100215. doi: 10.1016/j.jham.2025.100215. eCollection 2025 Mar.
To compare the costs of carpal tunnel release (CTR) performed in a minor procedure room using wide awake local anesthesia no tourniquet (WALANT), local anesthesia with a tourniquet (AL-T) and CTR in a conventional operating room (OR) with sedation. Additionally, we aimed to assess the anesthetic preferences of the Argentine Association of Hand and Upper Limb Reconstructive Surgery (AACM) members regarding CTR.
This cross-sectional, single-center study involved analyzing specific hospital costs associated with each anesthesia technique in both surgical settings. A report was obtained from the OR chief of our institution. Additionally, an anonymous survey was conducted among certified and main AACM members, gathering data on: (1) practice location, (2) preferred anesthesia type for CTR and reasons for not using WALANT/AL-T regularly, (3) years of practice, (4) preferred CTR surgical technique, and (5) willingness to change anesthesia preference if offered differential fees.
Performing CTR with WALANT and AL-T in a procedure room resulted in cost savings of 64 % and 65 %, respectively, compared to sedation in a conventional OR. The average duration for CTR, including cleaning and turnover time, was 34 min (±3) for WALANT, 33 min (±4) for AL-T, and 55 min (±8) for sedation in a conventional operating room.Out of 226 AACM members, 95 (42 %) responded to the survey. Among them, 42 % practiced in Buenos Aires (CABA), and only 35 % preferred using local anesthesia for CTR (16 % WALANT, 19 % AL-T). Nearly half (49 %) had over 16 years of experience. All respondents favored open or mini-approach techniques for CTR. Those who did not use WALANT or AL-T cited discomfort with patient interaction and perceived lack of benefits as reasons. However, 31 % indicated they would change their anesthesia preference if offered differential fees.
CTR with WALANT or AL-T in a procedure room reduces costs by over 65 % compared to sedation in a conventional OR. Despite cost benefits, sedation remains the predominant practice in Argentina, hindered by a lack of consensus and institutional incentives.
比较在小型手术室使用清醒局部麻醉无止血带（WALANT）、局部麻醉加止血带（AL-T）以及在配备镇静的传统手术室（OR）进行腕管松解术（CTR）的成本。此外，我们旨在评估阿根廷手部和上肢重建外科学会（AACM）成员对CTR的麻醉偏好。
这项横断面单中心研究涉及分析两种手术环境下每种麻醉技术相关的特定医院成本。从我们机构的手术室主任那里获取了一份报告。此外，对AACM认证成员和主要成员进行了一项匿名调查，收集以下数据：（1）执业地点，（2）CTR首选的麻醉类型以及不经常使用WALANT/AL-T的原因，（3）执业年限，（4）首选的CTR手术技术，以及（5）如果提供差价费用是否愿意改变麻醉偏好。
与在传统手术室进行镇静相比，在小型手术室使用WALANT和AL-T进行CTR分别节省了64%和65%的成本。CTR的平均时长，包括清洁和周转时间，WALANT为34分钟（±3），AL-T为33分钟（±4），在传统手术室进行镇静为55分钟（±8）。在226名AACM成员中，95名（42%）回复了调查。其中，42%在布宜诺斯艾利斯（CABA）执业，只有35%的人在CTR中首选使用局部麻醉（16%选择WALANT，19%选择AL-T）。近一半（49%）有超过16年的经验。所有受访者都倾向于采用开放或微创入路技术进行CTR。那些不使用WALANT或AL-T的人提到与患者互动时的不适以及认为缺乏益处是原因。然而，31%的人表示如果提供差价费用，他们会改变麻醉偏好。
与在传统手术室进行镇静相比，在小型手术室使用WALANT或AL-T进行CTR可降低成本超过65%。尽管有成本效益，但在阿根廷，由于缺乏共识和机构激励措施，镇静仍然是主要的做法。
