门诊上肢手术中清醒局部麻醉下无止血带技术（WALANT）的患者体验：一项关于围手术期疼痛和焦虑的横断面研究
Patient experiences of WALANT for outpatient upper limb surgery: A cross-sectional study of perioperative pain and anxiety.
作者信息
Govender Reshlan, Rocher Antoine G L, Rankin Mario T, Sondovana Khangelani, Phenyane Simphiwe C, O'Connor Megan
机构信息
Department of Orthopaedics, School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
School of Clinical Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
出版信息
J Coll Med S Afr. 2025 Jun 13;3(1):184. doi: 10.4102/jcmsa.v3i1.184. eCollection 2025.
BACKGROUND
Demands on South African operating theatres have led to more outpatient upper limb surgery being performed under wide awake local anaesthesia no tourniquet (WALANT). This study aimed to determine patients' anxiety and pain related to WALANT use in outpatient upper limb surgery, and to identify factors that increased the risk of heightened pain experiences.
METHODS
This multicentre cross-sectional study conducted between December 2022 and June 2024 utilised the 'strengthening the reporting of observational studies in epidemiology guidelines'. Patients receiving outpatient upper limb surgery under WALANT were prospectively recruited for participation in an investigator-administered questionnaire of 15 questions regarding their demographics, procedure, anxiety and pain experiences. Patients' anxiety and pain experiences were summarised, and relationships between demographic or procedural factors and anxiety or pain scores were tested.
RESULTS
In all, 85 patients were included. The most frequent procedures performed were tendon repairs and trigger releases (42% and 12% respectively). Of the total recruited patients, 45% reported moderate to severe anxiety perioperatively. The median visual analogue scale (VAS) score for pain of injection and procedure were 20 mm and 0 mm, respectively. Male patients and isiZulu speaking patients had lower VAS pain scores, while very anxious patients had higher VAS pain scores.
CONCLUSION
Forty-five per cent of patients who underwent outpatient upper limb surgery under WALANT experienced perioperative anxiety. They did not experience the anaesthetic or surgery as painful on average. Pain scores were related to perioperative anxiety. Future investigation should further explore the relationship between perioperative anxiety and pain.
CONTRIBUTION
Wide awake local anaesthesia no tourniquet is well tolerated in patients undergoing outpatient upper limb surgery.
背景
南非手术室的需求促使更多门诊上肢手术在清醒局部麻醉无止血带（WALANT）下进行。本研究旨在确定患者在门诊上肢手术中与使用WALANT相关的焦虑和疼痛情况，并识别增加疼痛体验加剧风险的因素。
方法
这项多中心横断面研究于2022年12月至2024年6月进行，采用了“加强流行病学观察性研究报告指南”。前瞻性招募接受WALANT下门诊上肢手术的患者，参与由研究者管理的包含15个问题的问卷，内容涉及他们的人口统计学信息、手术、焦虑和疼痛体验。总结患者的焦虑和疼痛体验，并测试人口统计学或手术因素与焦虑或疼痛评分之间的关系。
结果
总共纳入了85名患者。最常进行的手术是肌腱修复和扳机指松解术（分别为42%和12%）。在所有招募的患者中，45%报告围手术期有中度至重度焦虑。注射和手术疼痛的视觉模拟量表（VAS）评分中位数分别为20毫米和0毫米。男性患者和说isiZulu语的患者VAS疼痛评分较低，而非常焦虑的患者VAS疼痛评分较高。
结论
在WALANT下接受门诊上肢手术的患者中，45%经历了围手术期焦虑。他们平均没有感到麻醉或手术很疼。疼痛评分与围手术期焦虑有关。未来的研究应进一步探讨围手术期焦虑与疼痛之间的关系。
贡献
清醒局部麻醉无止血带在接受门诊上肢手术的患者中耐受性良好。
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