Operative outcomes for wide awake local anesthesia versus regional and general anesthesia for flexor tendon repair

2021 ◽  
Author(s):  
M. Kadhum ◽  
A. Georgiou ◽  
M. Kanapathy ◽  
D. Reissis ◽  
M. Akhavani ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Operative Outcomes ◽  
Wide Awake

Functional Outcomes of Flexor Tendon Repair in the Fingers: A Comparison of Wide-Awake Local Anesthesia No Tourniquet Versus Traditional Anesthesia

Hand ◽  
2022 ◽  
pp. 155894472110643
Author(s):  
Clay B. Townsend ◽  
Tyler W. Henry ◽  
Jonas L. Matzon ◽  
Daniel Seigerman ◽  
Samir C. Sodha ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Local Anesthesia ◽  
Functional Outcomes ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Complication Rates ◽  
Flexor Tendon Repair ◽  
Wide Awake ◽  
No Tourniquet

Background: Flexor tendon lacerations in the fingers are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA. Methods: All patients who underwent a primary flexor tendon repair in zone I and II without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations. Results: Sixty-five zone I (N = 21) or II (N = 44) flexor tendon repairs were included in the final analysis: 23 WALANT and 42 TA. There were no statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the groups. The final Quick Disabilities of the Arm, Shoulder, and Hand score in the WALANT group was 17.2 (SD: 14.4) versus 23.3 (SD: 18.5) in the TA group. There were no statistical differences between the groups with any final range of motion (ROM) parameters, grip strength, or Visual Analog Scale pain scores at the final follow-up. The WALANT group was found to have a slightly higher reoperation rate (26.1% vs 7.1%; P = .034) than the TA group. Conclusions: This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under WALANT. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.

Wide-awake Flexor Tendon Repair and Early Tendon Mobilization in Zones 1 and 2

Hand Clinics ◽  
2013 ◽  
Vol 29 (2) ◽  
pp. 207-213 ◽  
Author(s):  
Donald H. Lalonde ◽  
Alison L. Martin
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Wide Awake

scholarly journals Wide awake surgery for flexor tendon primary repair: A literature review

2020 ◽  
Author(s):  
Camillo Fulchignoni ◽  
Mario Alessandri Bonetti ◽  
Giuseppe Rovere ◽  
Antonio Ziranu ◽  
Giulio Maccauro ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Awake Surgery ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Flexor Tendon Injuries ◽  
Wide Awake

Flexor tendon injuries are extremely challenging conditions to manage for hand surgeons. Over the last few years enormous progress has been made for the treatment of these lesions with new surgical approaches being performed. One of these is the wideawake local anesthesia no tourniquet (WALANT) technique, also known as Wide Awake Technique that allows tendon repair under local anesthesia, enabling the tendon to move actively during surgery. Dynamic movement of the tendon during surgery is crucial for the orthopedic surgeon in order to understand if the tendon has been correctly repaired before leaving the operatory table. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using ((Flexor tendon injury) OR (flexor tendon) OR (injury muscle tendon) OR (flexor pollicis longus tendon) AND ((wide awake repair) OR (wide awake) OR (wide awake hand surgery))as search terms. Authors believe that WALANT is an enormous add-on in the management of patients with flexor tendon injuries mainly because it allows direct visualization of the repair during flexion and extension movement of the fingers and also because it avoids general anesthesia or brachial plexus being more cost effective. The aim of these review was therefore to sum up the evidences available so far on the wade awake technique as an emerging treatment for patients with flexor tendon injuries.

Wide-Awake Flexor Tendon Repair

2009 ◽  
Vol 123 (2) ◽  
pp. 623-625 ◽  
Author(s):  
Donald H. Lalonde
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Wide Awake

scholarly journals Wide-awake local anaesthesia no tourniquet (WALANT) vs regional or general anaesthesia for flexor tendon repair in adults: protocol for a systematic review and meta-analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Grant S. Nolan ◽  
Ailbhe L. Kiely ◽  
Tomas Madura ◽  
Alexia Karantana
Keyword(s):  
Systematic Review ◽  
Regional Anaesthesia ◽  
Flexor Tendon ◽  
Meta Analysis ◽  
Tendon Repair ◽  
Awake Surgery ◽  
Flexor Tendon Repair ◽  
Patient Reported ◽  
Flexor Tendon Injuries ◽  
Wide Awake

Abstract Background Flexor tendon injuries most commonly occur following a penetrating injury to the hand or wrist. These are challenging injuries and the standard treatment is surgical repair under general or regional anaesthesia. ‘Wide-awake’ surgery is an emerging technique in hand surgery where a conscious patient is operated on under local anaesthetic. The vasoconstrictive effect of adrenaline (epinephrine) creates a ‘bloodless’ operating field and a tourniquet is not required. The potential advantages include intra-operative testing of the repair; removal of the risks of general anaesthesia; reduced costs; no aerosol generation from intubation therefore reduced risk of COVID-19 spread to healthcare professionals. The aim of this study will be to systematically evaluate the evidence to determine if wide-awake surgery is superior to general/regional anaesthetic in adults who undergo flexor tendon repair. Methods We designed and registered a study protocol for a systematic review and meta-analysis of comparative and non-comparative studies. The primary outcome will be functional active range of motion. Secondary outcomes will be complications, resource use (operative time) and patient-reported outcome measures. A comprehensive literature search will be conducted (from 1946 to present) in MEDLINE, EMBASE, CINAHL, and Cochrane Library. Grey literature will be identified through Open Grey, dissertation databases and clinical trials registers. All studies on wide-awake surgery for flexor tendon repair will be included. The comparator will be general or regional anaesthesia. No limitations will be imposed on peer review status or language of publication. Two investigators will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion or referral to a third author when necessary. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct a random effects meta-analysis. Discussion This systematic review will summarise the best available evidence and definitively establish if function, complications, cost, or patient-reported outcomes are improved when flexor tendons are repaired using wide-awake technique. It will determine if this novel approach is superior to general or regional anaesthesia. This knowledge will help guide hand surgeons by continuing to improve outcomes from flexor tendon injuries. Systematic review registration PROSPERO CRD42020182196

Evaluation of flexor tendon repair (zone II) with Wide Awake Anesthesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Adel Zaghloul Fayed ◽  
Naglaa Mohamed Abdel Aziz ◽  
Ebrahim Mohamed Amin Abdel Gawad ◽  
Ibrahim Hussien Kamel ◽  
Ahmed Elshahat
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Rehabilitation Protocol ◽  
Flexor Tendon Injuries ◽  
Zone Ii ◽  
Active Rehabilitation ◽  
Wide Awake

Abstract Background Recent advances in hand surgery has been the movement away from tourniquet surgery, which often requires sedation or GA and the patient will be awake and cooperative. Wide awake approach depends on the safety of adrenaline which is now well established. This review will evaluate the role of the wide awake approach in reducing rupture and tenolysis rate after flexor tendon repair zone 2. Objective To evaluate the functional outcome of flexor tendon repair zone II (most challengeable) under wide awake anesthesia. Patients and Methods After approval of local ethical committee of faculty of medicine Ain Shams University, this Prospective study has been conducted targeting patients with acute zone II flexor tendon injuries admitted at El Sahel Teaching Hospital within the period from September 2019 till January 2020, and their follow up for minimum three months at outpatient clinic. A Written informed consent explaining the whole procedure under study in this research has been obtained from all patients and absolute confidentiality as regard the patients’ names and addresses was given special care and attention. Final outcome evaluated by Original Strickland evaluation system. Results Using the wide awake technique provides an optimal opportunity to test repair strength through Intra-operative Total Active Movement (ITAM) making the surgeon much more comfortable to initiate early active motion. Besides, rising trend toward using early active rehabilitation protocol in case of strong repair using four or more strands repairs is recently supported in literature. This study adopted early active rehabilitation protocol with slight differences among them Conclusion This preliminary study assessing the outcomes of primary tendon repair in flexor tendon injuries in zone II using the wide-awake technique demonstrates encouraging results, being satisfactory for both surgeons and patients that makes this new approach a competitive to the other approaches of flexor tendon repair implemented under conventional methods of anesthesia.

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