14 results on '"Wide awake hand surgery"'
Search Results
2. Wide Awake Local Anesthesia No Tourniquet Technique in Hand Surgery: The Patient Experience.
- Author
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Pina, Matthew, Cusano, Antonio, LeVasseur, Matthew R., Olivieri-Ortiz, Rafael, Ferreira, Joel, and Parrino, Anthony
- Abstract
Background: We attempted to evaluate patient satisfaction and overall experience during wide awake, local anesthesia, with no tourniquet (WALANT) hand surgery and quantify surgery-related outcomes. Methods: We conducted a retrospective analysis of patient demographics, comorbidities, and patient reported outcomes via Single Assessment Numeric Evaluation (SANE) scores collected pre- and postoperatively of patients undergoing WALANT surgery by the 2 participating senior authors. A solution of 1% lidocaine with 1:100,000 epinephrine was used by 1 surgeon, while the other used a 1:1 ratio of 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine for local anesthetic injection. Patients were administered a postoperative survey to assess patient experience, including anxiety and pain levels, and overall satisfaction in the perioperative period. Results: Overall, 97.7% of patients indicated that they would undergo a WALANT-style surgery if indicated in the future, 70.5% ate the day of surgery, and a total of 39.1% of patients reported driving to and from surgery. Postoperative SANE scores increased as compared with preoperative scores across all patients. The use of combination 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine was associated with lower intraoperative and postoperative visual analog scale pain scores. Conclusions: WALANT hand surgery was generally well tolerated with excellent surgical outcomes. Patients reported ease of preparation for surgery, faster recovery, and lack of anesthetic side effects as the main benefits of wide-awake surgery. Combination use of lidocaine and bupivacaine may be better than lidocaine alone with respect to pain control in the initial recovery period. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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3. WALANT: A Discussion of Indications, Impact, and Educational Requirements
- Author
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Shahab Shahid, Noman Saghir, Reyan Saghir, Quillan Young-Sing, and Benjamin H. Miranda
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WALANT ,wide awake hand surgery ,local anesthesia no tourniquet ,education ,training ,simulation ,Surgery ,RD1-811 - Abstract
Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.
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- 2022
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4. WALANT: A Discussion of Indications, Impact, and Educational Requirements.
- Author
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Shahid, Shahab, Saghir, Noman, Saghir, Reyan, Young-Sing, Quillan, and Miranda, Benjamin H.
- Subjects
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TOURNIQUETS , *CONDUCTION anesthesia , *FLEXOR tendons , *LOCAL anesthesia , *PATIENT selection , *SURGICAL indications , *TRAINING of surgeons , *GENERAL anesthesia - Abstract
Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive fromreduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flowoxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
5. The Influence of Mental Health Diagnoses on Patient Experiences and Outcomes in Patients Undergoing WALANT Hand Surgery.
- Author
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Ford B, Neumann D, Pina M, Olivieri-Ortiz R, Ferreira J, and Parrino A
- Abstract
Purpose: The purpose of this study was to gauge whether patients with preexisting mental health conditions have desirable outcomes when undergoing wide-awake local anesthesia with no tourniquet (WALANT) hand surgery., Methods: A retrospective review of 133 patients who underwent WALANT surgery by 2 senior authors from August 2019 to October 2020 was performed. Patients were administered a 10-question postoperative survey detailing perioperative pain, experience, and satisfaction concerning their procedure. Analysis was performed for patient responses to the questionnaire, demographics, comorbidities, and patient-reported outcomes using the Single Assessment Numeric Evaluation (SANE)., Results: There were 61 patients identified as having a preexisting psychiatric diagnosis compared to 70 patients without who underwent WALANT surgery. Comparing psychiatric diagnosis and nonpsychiatric diagnosis cohorts, there was no significant difference in preoperative anxiety (3.75 vs 3.30), pain during procedure (0.67 vs 0.56), or pain after surgery (4.89 vs 4.26). There was a significantly higher pain score with preoperative injection in the psychiatric diagnosis cohort (4.07 vs 2.93). When asked if they would have a WALANT procedure again, 95.1% of patients in the psychiatric diagnosis cohort and 98.6% of patients in the nonpsychiatric diagnosis group said they would. There was no significant difference in average preoperative SANE scores (59.67 [no psych diagnosis] vs 61.70 [psych diagnosis]) or postoperative SANE scores (82.82 [no psych diagnosis] vs 81.06 [psych diagnosis]) between the two cohorts., Conclusions: WALANT surgery was nearly as well tolerated in patients with a preexisting mental health diagnosis when compared to those without a preexisting diagnosis., Clinical Relevance: Surgeons who are currently or potentially performing WALANT surgery should not rule out patients as eligible candidates because of a prior diagnosis of a mental health condition., (© 2024 The Authors.)
- Published
- 2024
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6. Wide Awake Dupuytren’s Fasciectomy: A Pathoanatomical Approach
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Bismil, Quamar M. K., Bismil, M. S. K., and Rizzo, Marco, editor
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- 2016
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7. Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial.
- Author
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Iqbal, Hafiz J., Doorgakant, Ashtin, Rehmatullah, Nader N. T., Ramavath, Ashok L., Pidikiti, Prasad, and Lipscombe, Stephen
- Abstract
We conducted a prospective randomized controlled trial to investigate carpal tunnel decompression under local anaesthesia. Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an arm tourniquet and 36 without tourniquet but with a local anaesthetic mixture containing adrenaline. Patients who underwent carpal tunnel decompression using a tourniquet experienced a significantly greater degree of pain when compared with those who did not have a tourniquet. Pain and hand function improved to a similar degree in both groups. We conclude that carpal tunnel decompression performed with a tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a tourniquet.Level of evidence: I [ABSTRACT FROM AUTHOR]
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- 2018
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8. Wide-Awake Local Anesthesia No Tourniquet (WALANT) for Flexor Tendon Repairs as Change in Practice During the COVID-19 Pandemic: A Retrospective Cohort Study With Outcomes.
- Author
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Bamal R, Alnobani O, Bastouros E, Nolan G, Morris E, Griffiths S, and Bell D
- Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic forced many changes. In our unit, there was a significant shift from traditional anesthesia (TA) which included general or regional anesthesia, to Wide-Awake Local Anesthesia No Tourniquet (WALANT) for the treatment of flexor tendon injuries. Zones I and II injuries have always been a challenge. The primary aim of this study is to compare the 12-week range of motion (ROM) flexor tendon repair outcomes between the TA group and wide-awake (WA) group patients. The secondary aim is to compare the complications and the follow-up rate between the two groups., Methods: All patients who underwent a primary finger flexor tendon repair in zone I or II without tendon graft for closed avulsions or open lacerations between April 2020 and March 2021 were included in the study. Electronic medical records were reviewed to record demographics, follow-up, ROM outcomes and complications., Results: Forty-four patients with 49 injured fingers were in the WA group, and 24 patients with 37 injured fingers were in the TA group. A complete follow-up with 12-week ROM outcomes was available for 15 patients with 16 injured fingers in the WA group and nine patients with 13 injured fingers in the TA group. Excellent to good outcomes in the WA group were reported in 56% of the cases versus 31% in the TA group, although the difference was not statistically significant. There were similar complications in both groups, with an overall rupture rate of 11.6%, a tenolysis rate of 3.5% and a reoperation rate of 9.3%. Complete 12-week follow-up was completed by 41% of patients overall after taking tendon ruptures into account., Conclusions: This is one of the first studies comparing zones I and II flexor tendon ROM outcomes between WA anesthesia and TA. Overall, there was a trend toward superior ROM outcomes in the WA group, with similar complication rates in both groups. The difference between ROM outcomes was not statistically significant and the small sample size undermined the strength of the study. To provide stronger evidence, better-designed prospective studies are suggested that would compare WA techniques with TA techniques., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bamal et al.)
- Published
- 2023
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9. Wide-Awake Tenolysis of a Pectoralis Major to Biceps Transfer After Near Total Arm Avulsion Amputation.
- Author
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Sankaran A, Thushara KR, Ajaykumar V, and Mohankumar EG
- Abstract
Wide-awake surgery is transforming many areas of hand surgery. We report a distinctive case of an avulsion near total amputation of the right dominant arm, which required emergent shaft humerus fracture fixation and brachial artery repair with a vein graft. Three months post-injury, the patient underwent long segment nerve grafts of the median and ulnar nerves, with pectoralis major to biceps transfer for elbow flexion reconstruction. Since the patient failed to gain any functional movement of the elbow, we explored the transfer under wide-awake local anaesthesia using lignocaine and adrenaline. Four months after the wide-awake release, the patient had gained 70 degrees elbow flexion against gravity and 110 degrees with gravity eliminated. On the Waikakul scale, the result was categorized as 'Good'. Wide-awake anaesthesia allowed sufficient release of a large muscle transfer in a prior traumatised zone with a satisfactory result., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sankaran et al.)
- Published
- 2022
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10. Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome.
- Author
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Karamanis N, Stamatiou G, Vasdeki D, Sakellaridis N, Xarchas KC, Varitimidis S, and Dailiana ZH
- Abstract
Introduction Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course., Competing Interests: Conflict of Interest None declared., (Society of Indian Hand & Microsurgeons. All rights reserved. Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor, Sector 2, Noida-201301 UP, India.)
- Published
- 2021
- Full Text
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11. The rise of wide awake hand surgery - Contribution from Turkey
- Author
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Emre Ozdemir, Metin Manouchehr Eskandari, Kadir Çevik, Ender Gumusoglu, and Egemen Ayhan
- Subjects
030222 orthopedics ,Tourniquet ,medicine.medical_specialty ,Lidocaine ,business.industry ,Sedation ,Wide awake hand surgery ,lcsh:Surgery ,Hand surgery ,WALANT ,lcsh:RD1-811 ,030230 surgery ,Patient Cooperation ,03 medical and health sciences ,Active motion ,0302 clinical medicine ,Anesthesia ,medicine ,Local anesthesia ,epinephrine ,medicine.symptom ,business ,tourniquet ,medicine.drug ,Patient comfort - Abstract
Objectives: Recently, many surgeons started to prefer wide awake local anesthesia no tourniquet (WALANT) approach to provide an almost bloodless field for the vast majority of hand surgery procedures. We aimed to present our two-year experience with WALANT technique. Methods: A wide variety of 682 hand surgery operations in 626 patients were performed with WALANT technique. For infiltrative local anesthesia, the mixture of 1% lidocaine, 1:100.000 epinephrine and 8.4% bicarbonate was prepared. The need for intraoperative sedation and intraoperative patient cooperation were evaluated. Patients' fingers were observed in case of postoperative circulatory compromise. A simple cost-effectivity analysis for the anesthesia types was performed. Results: Mean age of the patients was 43.7. None of the patients needed intraoperative sedation, and patients obeyed to orders of surgeon throughout the procedure. The postoperative circulatory compromise was observed in two fingers; one finger resolved spontaneously and the other rescued with phentolamine. WALANT technique was more cost-effective than Bier block or general anesthesia. Conclusion: The WALANT technique seems like a great innovation to perform a wide variety of hand surgery cases. Increased patient comfort without a tourniquet, cost-effectivity, no preoperative tests, no risks of general anesthesia, no need to stay in the hospital overnight, and intraoperative active motion assessment facility are important advantages. [Hand Microsurg 2018; 7(3.000): 125-134]
- Published
- 2018
12. Endoscopic Carpal Tunnel Release Using Wide-Awake Anesthesia.
- Author
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Ly TV, Urban V, Meuli-Simmen C, and Pasternak I
- Abstract
Purpose: We report on patient and surgeon experience after single-port endoscopic carpal tunnel release (CTR) using wide-awake local anesthesia no tourniquet (WALANT) technique., Methods: From July to November 2018, patients undergoing endoscopic CTR with WALANT were prospectively included. Follow-up was 3 months. Patient ratings before, during, and after the operation were collected. We recorded the surgeon's experience during surgery compared with the endoscopic CTR under local anesthesia with exsanguination and tourniquet. Complications were defined as nerve injury, infection, or the need for revision surgery., Results: The cohort consisted of 20 patients (24 wrists). All patients except one reported a complete or substantial decrease of symptoms. The 2 surgeons involved judged the procedure to be technically more demanding owing to impaired visualization (33%) caused by increased bleeding and edema in the operative field. There was one conversion from endoscopic to open surgery., Conclusions: We recommend starting single-port endoscopic CTR using WALANT with a noninflated tourniquet in place for use when necessary., Type of Study/level of Evidence: Therapeutic IV., (© 2019 The Authors.)
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- 2019
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13. Wide Awake Hand Surgery Under Local Anesthesia No Tourniquet in South America.
- Author
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Pires Neto PJ, Ribak S, and Sardenberg T
- Subjects
- Anesthetics, Local administration & dosage, Brazil, Epinephrine administration & dosage, History, 21st Century, Humans, Lidocaine administration & dosage, Vasoconstrictor Agents administration & dosage, Ambulatory Surgical Procedures, Anesthesia, Local, Hand surgery, Orthopedic Procedures
- Abstract
The authors report the introduction and development of wide awake hand surgery under local anesthesia no tourniquet (WALANT) in South America, specifically in Brazil, where thousands of cases have already been performed with this technique. This was largely stimulated by Dr Lalonde's first visit to Brazil in 2012. The authors began with smaller procedures such as trigger fingers and carpal tunnels, which were easily implemented. There has been an increase in the number of more complex procedures, such as flexor tenolysis or tendon transfers, in which patient cooperation can help improve results., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2019
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14. Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial.
- Author
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Iqbal HJ, Doorgakant A, Rehmatullah NNT, Ramavath AL, Pidikiti P, and Lipscombe S
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- Anesthetics, Local administration & dosage, Disability Evaluation, Epinephrine administration & dosage, Female, Humans, Intraoperative Complications, Lidocaine administration & dosage, Male, Middle Aged, Pain prevention & control, Vasoconstrictor Agents administration & dosage, Visual Analog Scale, Anesthesia, Local, Carpal Tunnel Syndrome surgery, Decompression, Surgical, Pain etiology, Tourniquets
- Abstract
We conducted a prospective randomized controlled trial to investigate carpal tunnel decompression under local anaesthesia. Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an arm tourniquet and 36 without tourniquet but with a local anaesthetic mixture containing adrenaline. Patients who underwent carpal tunnel decompression using a tourniquet experienced a significantly greater degree of pain when compared with those who did not have a tourniquet. Pain and hand function improved to a similar degree in both groups. We conclude that carpal tunnel decompression performed with a tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a tourniquet., Level of Evidence: I.
- Published
- 2018
- Full Text
- View/download PDF
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