Shadid Omar, Novo Jennifer, Saini Raj, Marcaccini Gianluca, Sacks Brett K, Rozen Warren M, Seth Ishith, Cuomo Roberto
Faculty of Medicine and Surgery, The University of Melbourne, Melbourne 3051, Australia.
Faculty of Medicine and Surgery, University of Notre Dame, Sydney 2010, Australia.
J Clin Med. 2025 Aug 30;14(17):6146. doi: 10.3390/jcm14176146.
Hand surgery is increasingly transitioning from hospital operating theatres to outpatient settings, requiring anaesthetic methods that are efficient, cost-effective, and patient-centred. Traditional anaesthesia, such as general anaesthesia, poses challenges including prolonged recovery and physiological stress. Novel strategies, such as Wide-Awake Local Anaesthesia No Tourniquet (WALANT), ultrasound-guided distal nerve blocks, and adjunctive approaches (vapocoolant spray, patient-controlled regional analgesia, cryoanalgesia, jet injectors), have emerged to address these limitations. This narrative review consolidates current evidence regarding the efficacy, applicability, and economic implications of these evolving anaesthesia techniques. A literature search was conducted across MEDLINE, Embase, CENTRAL, and Scopus databases up to 1 June 2025. Inclusion criteria were English-language original studies on WALANT, vapocoolant sprays, ultrasound-guided distal nerve blocks, or emerging adjunctive anaesthesia methods applicable to hand and upper limb surgery. Exclusion criteria included non-English publications and those without original clinical data. Two independent reviewers screened and selected studies, ensuring relevance and methodological quality. WALANT can provide high patient satisfaction, cost savings of 70-85%, and allow for real-time functional testing during surgery. Ultrasound-guided nerve blocks provided targeted analgesia, preserved elbow function, reduced the need for sedation, and improved perioperative efficiency. Adjuncts such as vapocoolant sprays significantly decreased needle-injection discomfort, offering quick and economical analgesia for superficial procedures. Other emerging adjuncts, including patient-controlled regional anaesthesia (PCRA), cryoanalgesia, and jet injectors, offered additional patient-tailored pain management options, although with higher resource demands. The review highlights the transformative potential of WALANT and adjunctive techniques to enhance efficiency, patient experience, and cost-effectiveness in hand surgery. Despite clear benefits, optimal application requires tailored patient selection, clinician familiarity, and consideration of procedure-specific demands.
手部手术正日益从医院手术室转向门诊环境，这就需要高效、具有成本效益且以患者为中心的麻醉方法。传统麻醉方式，如全身麻醉，存在包括恢复时间延长和生理应激等挑战。新型策略，如清醒局部麻醉无止血带（WALANT）、超声引导下远端神经阻滞以及辅助方法（冷雾剂喷雾、患者自控区域镇痛、冷冻镇痛、喷射注射器）已出现以应对这些局限性。本叙述性综述整合了关于这些不断发展的麻醉技术的疗效、适用性和经济影响的当前证据。截至2025年6月1日，在MEDLINE、Embase、CENTRAL和Scopus数据库中进行了文献检索。纳入标准为关于WALANT、冷雾剂喷雾、超声引导下远端神经阻滞或适用于手部和上肢手术的新兴辅助麻醉方法的英文原创研究。排除标准包括非英文出版物以及没有原始临床数据的那些研究。两名独立审稿人筛选并选择研究，确保相关性和方法学质量。WALANT可提供高患者满意度、节省70 - 85%的成本，并允许在手术期间进行实时功能测试。超声引导下神经阻滞提供靶向镇痛、保留肘部功能、减少镇静需求并提高围手术期效率。冷雾剂喷雾等辅助方法显著降低了注射针时的不适感，为浅表手术提供快速且经济的镇痛。其他新兴辅助方法，包括患者自控区域镇痛（PCRA）、冷冻镇痛和喷射注射器，提供了更多针对患者的疼痛管理选择，尽管资源需求更高。该综述强调了WALANT和辅助技术在提高手部手术效率、患者体验和成本效益方面的变革潜力。尽管有明显益处，但最佳应用需要进行个性化的患者选择、临床医生的熟悉程度以及考虑特定手术的需求。
