Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity

2021 ◽  
pp. 175319342110295
Author(s):  
Donald Lalonde ◽  
Egemen Ayhan ◽  
Amir Adham Ahmad ◽  
Steven Koehler
Keyword(s):  
Ulnar Nerve ◽  
Local Anaesthesia ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Decompression Surgery ◽  
Entrapment Neuropathies ◽  
Fracture Management ◽  
Without Tourniquet ◽  
Wide Awake ◽  
Nerve Decompression Surgery

Hand surgery is rapidly changing. The wide-awake approach, minimum dissection surgery and early protected movement have changed many things. This is an update of some of the important changes regarding early protected movement with K-wired finger fracture management, simplification of nerve decompression surgery, such as elbow median and ulnar nerve releases, and some new areas in performing surgery with wide-awake local anaesthesia without tourniquet.

Digital revascularization and replantation using the wide-awake hand surgery technique

2017 ◽  
Vol 42 (6) ◽  
pp. 621-625 ◽  
Author(s):  
JKF Wong ◽  
CH Lin ◽  
NJ Chang ◽  
HC Chen ◽  
YT Lin ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Case Series ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Tissue Necrosis ◽  
Level Of Evidence ◽  
Operator Experience ◽  
Soft Tissue Necrosis ◽  
Wide Awake ◽  
Superficial Soft Tissue

The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the ‘wide-awake’ anaesthetic technique. A temporary digital tourniquet (< 20 min) was used in three cases to identify structures quickly. The anastomoses were performed under local anaesthesia without a tourniquet. All cases had successful re-establishment of blood flow with good perfusion to the digital tips; no cases were re-explored because of vascular crisis. Four cases had minor superficial soft tissue necrosis that healed secondarily. We conclude that digital revascularization and replantation can be performed under local anaesthesia with use of adrenaline and without detriment to the traumatized digit provided careful patient selection and adequate operator experience are available. Level of evidence: IV

scholarly journals Patients' Perceptions of Carpal Tunnel and Ulnar Nerve Decompression Surgery

2011 ◽  
Vol 38 (2) ◽  
pp. 268-273 ◽  
Author(s):  
Kathleen Joy Khu ◽  
Mark Bernstein ◽  
Rajiv Midha
Keyword(s):  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Decompression Surgery ◽  
Effective Treatment Option ◽  
Nerve Decompression ◽  
Entrapment Neuropathies ◽  
Operative Care ◽  
Future Care ◽  
Nerve Decompression Surgery

Background:Carpal tunnel syndrome and ulnar nerve entrapment at the elbow are the most common entrapment neuropathies seen in adults. Surgery for nerve decompression is a safe and effective treatment option, and is usually performed under local anesthesia and as an outpatient procedure. This study aimed to explore patients' satisfaction and other aspects of the overall experience with this type of surgery.Methods:Qualitative research methodology was used. Semi-structured, open-ended interviews were conducted with 30 adult patients who had undergone carpal tunnel release or ulnar nerve decompression at the elbow 6-24 months prior. Interviews were digitally audio recorded and transcribed, and the data subjected to thematic analysis.Results:Four overarching themes emerged from the data: (1) most patients did not perceive their condition to be serious; (2) patients were satisfied with the overall surgical experience; (3) the outcome was more important to patients than the process; and (4) majority of patients had a realistic expectation of outcomes.Conclusions:Patients had a positive experience with carpal tunnel and ulnar nerve decompression surgery, although their level of satisfaction was dependent on the surgical outcome. Areas requiring improvement, specifically information about post-operative care and expectations of recovery, will be implemented in the future care of patients.

scholarly journals Positive patient experience of wide awake local anaesthesia no tourniquet (WALANT) hand surgery in the government setting: a prospective descriptive study

2021 ◽  
Vol 20 (3) ◽  
Author(s):  
Jaco J Naude ◽  
Odette Koch ◽  
Ludwig W Schmidt ◽  
Theo LB le Roux
Keyword(s):  
Patient Experience ◽  
Carpal Tunnel ◽  
Local Anaesthesia ◽  
Surgical Procedure ◽  
Hand Surgery ◽  
Descriptive Study ◽  
Trigger Finger ◽  
The Mean ◽  
Wide Awake ◽  
No Tourniquet

ABSTRACT BACKGROUND: The purpose of this study was to establish a subjective patient experience with wide awake local anaesthesia no tourniquet (WALANT) procedures performed in the institution from May 2019 to March 2020. WALANT surgery was initiated to improve standard operating procedure and to decrease theatre burden METHODS: This prospective, descriptive study included 100 patients with a mean age of 59 years who required either a carpal tunnel or trigger finger release. The patients' pain experience was documented on the visual analogue scale (VAS) for the local anaesthetic injection and the surgical procedure. Overall experience was assessed on the patient's preference to have the procedure performed by the WALANT method or the conventional method RESULTS: One hundred patients were included, of which 67 had medical comorbidities. The mean VAS score was 1.5 (SD±1.6) with pain on injection. The mean VAS pain score during the surgical procedure was 0.2 (SD±0.7). One hundred per cent of patients (100/100) felt they would do the WALANT outpatient procedure again instead of admission to hospital and surgery in the theatre. Two complications occurred related to wound care problems, and were successfully managed. None of the patients required reoperations for incomplete release of the carpal tunnel or trigger finger surgery CONCLUSION: The results of this study suggest that minor hand surgery using the WALANT protocol can be performed effectively and with high patient satisfaction rates in the orthopaedic outpatient clinic, and is a useful tool in the skillset of a hand surgeon Level of evidence: Level 4 Keywords: WALANT, hand surgery, trigger finger, carpal tunnel release

Wide Awake Hand Surgery

2017 ◽  
Vol 22 (03) ◽  
pp. 292-296 ◽  
Author(s):  
Line Lied ◽  
Grethe E. Borchgrevink ◽  
Vilhjalmur Finsen
Keyword(s):  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Numerical Scale ◽  
Lidocaine Injection ◽  
One Year ◽  
Wide Awake ◽  
General Care ◽  
General Period

Background: “Wide awake hand surgery”, where surgery is performed in local anaesthesia with adrenaline, without sedation or a tourniquet, has become widespread in some countries. It has a number of potential advantages and we wished to evaluate it among our patients. Methods: All 122 patients treated by this method during one year were evaluated by the surgeons and the patients on a numerical scale from 0 (best/least) to 10 (worst/most). Theatre time was compared to that recorded for a year when regional or general anaesthesia had been used. Results: The patients’ mean score for the general care they had received was 0.1 (SD 0.6), for pain during lidocaine injection 2.4 (SD 2.2), for pain during surgery 0.9 (SD 1.5), and for other discomfort during surgery 0.5 (SD 1.4). Eight reported that they would want general anaesthesia if they were to be operated again. The surgeons’ mean evaluation of bleeding during surgery was 1.6 (SD 1.8), oedema during surgery 0.4 (SD 1.1), general disadvantages with the method 1.0 (SD 1.6) and general advantages 6.5 (SD 4.3). The estimation of advantages was 9.9 (DS 0.5) for tendon suture. 28 patients needed intra-operative additional anaesthesia. The proportion was lower among trained hand surgeons and fell significantly during the study period. Non-surgical theatre time was 46 (SD 15) minutes during the study period and 55 (SD 22) minutes during the regional/general period (p < 0.001). This gain was cancelled out by a longer surgery time during the wide awake period. Conclusions: Wide awake surgery is fully acceptable to most patients. It has a number of advantages over general or regional anaesthesia, but we feel it is unlikely to improve the efficiency of the operating theatre.

Anaesthesia

2018 ◽  
Author(s):  
Alistair Phillips ◽  
Harry Akerman
Keyword(s):  
Local Anaesthetic ◽  
Brachial Plexus Block ◽  
Hand Surgery ◽  
General Anaesthetic ◽  
Small Field ◽  
Muscle Paralysis ◽  
Peripheral Nerve Blockade ◽  
Without Tourniquet ◽  
Plexus Block ◽  
Wide Awake

Pain-free surgery can be imposed on the hand and wrist without resort to general anaesthetic. Options include local anaesthetic infiltration which can, in higher volumes mixed with adrenaline, allow surgery without a tourniquet. This technique (wide awake local anaesthetic without tourniquet or WALANT) permits the patient to move the fingers without the muscle paralysis induced by the regional anaesthetic and tourniquet, adding invaluable information, e.g. in tendon transfers. The efficacy of specific peripheral nerve blockade and brachial plexus block can be enhanced by ultrasound or nerve stimulation. Intravenous blockade (Bier’s) is effective. Tourniquets (finger, forearm, above elbow) are essential in hand surgery to provide a view unimpeded by blood (although WALANT can achieve this at the expense of a more oedematous field for procedures in a small field).

scholarly journals Timed wake-up anaesthesia in hand: A modification to wide awake surgery of hand

2016 ◽  
Vol 49 (03) ◽  
pp. 378-383 ◽  
Author(s):  
Jagannath Kamath ◽  
Trivikram Shenoy ◽  
Nikil Jayasheelan ◽  
Naufal Rizwan ◽  
Vartika Sachan ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Full Range ◽  
Hand Surgery ◽  
Awake Surgery ◽  
Modified Technique ◽  
Upper Arm ◽  
Modified Method ◽  
Hand Wash ◽  
Wide Awake ◽  
Fine Tune

ABSTRACT Introduction: Wide awake surgery of the hand (WASH) is a well-accepted technique in hand surgery which allows the surgeon to identify and rectify on the table of some of the inadvertent shortcomings in the surgical procedures to optimise the final outcome. The advantage, however, precludes the use of tourniquet. We describe a modified method which preserves all the advantages of WASH and allows the surgeon to use tourniquet. Patients and Methods: Thirty-one cases of hand surgeries were carried out using the modified technique where a wrist block was supplemented with the ultra-short acting intravenous propofol which allowed the surgeon to use the upper arm tourniquet. The propofol infusion was stopped, and the tourniquet was released after the important surgical step. Within an average of 10 min of stoppage of the infusion, all the patients were awake for active intraoperative painless movements to aid the surgeon to identify, rectify and fine tune the procedure to optimise the results. Results: Five of the 31 patients needed correction based on the intraoperative movements. All the 31 patients were pain free at the surgical site during surgery. All the 31 patients were cooperative enough to perform full range of pain-free intraoperative movements. No patient experienced significant tourniquet pain during the procedure. Patient’s and surgeon’s satisfaction at the end of the procedure has been quite satisfactory. Conclusion: Timed wake-up anaesthesia, an improvement over the original WASH, has been suggested where the surgeon can add without subtracting the benefits of the procedure in the form of usage of the tourniquet providing the clear tissue plane and haemostasis during the surgery. However, an additional cost is incurred for the use of anaesthesia and equipment should be kept in mind.

scholarly journals Wide-Awake Anesthesia in the In-Office Procedure Room: Lessons Learned

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 481-485 ◽  
Author(s):  
Robert E. Van Demark ◽  
Hillary A. Becker ◽  
Matthew C. Anderson ◽  
Vanessa J. S. Smith
Keyword(s):  
Hand Surgery ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Lessons Learned ◽  
Awake Surgery ◽  
Office Procedure ◽  
Concurrent Use ◽  
Wide Awake ◽  
No Tourniquet ◽  
Procedure Room

Background: Wide-awake local anesthesia and no tourniquet (WALANT) has become more popular in hand surgery. Without a tourniquet, there is no need for preoperative testing or sedation. The use of lidocaine with epinephrine has allowed a larger variety of cases to be done safely in an outpatient setting instead of the hospital. “Minor field sterility,” which uses fewer drapes and tools to accomplish the same procedures, is a concept that is also gaining recognition. Methods: Investigation of hand surgeons performing a majority of cases using WALANT and minor field sterility was the beginning of seeing its potential at our institution. Administration was concerned about patient safety, cost-effectiveness, and patient satisfaction of the proposed changes. Analysis of our institution to determine location of these procedures was also imperative to using WALANT. Results: An in-office procedure room was built to allow for WALANT and minor field sterility. The requirements and logistics of developing an in-office procedure room for wide-awake surgery are reviewed in this article. Conclusions: The concurrent use of WALANT and minor field sterility has created a hand surgery practice that is cost-effective for the patient and the facility and resulted in excellent patient outcomes and satisfaction.

Virtual reality may reduce anxiety and enhance surgical experience during wide-awake local anaesthesia no tourniquet surgery: A report of two cases

2021 ◽  
pp. 175045892098404
Author(s):  
Goutam Krish ◽  
Igor Immerman ◽  
Sakura Kinjo
Keyword(s):  
Virtual Reality ◽  
Case Report ◽  
Local Anaesthesia ◽  
Hand Surgery ◽  
Perioperative Period ◽  
The Novel ◽  
Patient Anxiety ◽  
Surgical Experience ◽  
Wide Awake ◽  
No Tourniquet

Virtual reality is an immersive experience that has been gaining acceptance in the field of medicine as a tool for reducing patient anxiety. We recently observed the effectiveness of this technology in wide-awake local anaesthesia no tourniquet (WALANT) surgeries. Here we report two cases of patients who used a virtual reality device during hand surgery using the WALANT technique. Both patients reported that the use of VR technology reduced their anxiety and improved their overall experience during surgery. This case report highlights the novel use of virtual reality during hand surgeries where the patients were awake. Based on these two cases, virtual reality may have the potential to reduce anxiety during the perioperative period and enhance a patient’s overall experience in WALANT surgeries.

Patients’ perspective of wide-awake hand surgery — 100 consecutive cases

2013 ◽  
Vol 38 (9) ◽  
pp. 992-999 ◽  
Author(s):  
I. Teo ◽  
W. Lam ◽  
P. Muthayya ◽  
K. Steele ◽  
S. Alexander ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Tendon Transfer ◽  
Hand Surgery ◽  
Postal Questionnaire ◽  
Awake Surgery ◽  
General Anaesthetic ◽  
Satisfaction Level ◽  
High Satisfaction ◽  
Wide Awake ◽  
Patients Perspective

The wide-awake hand surgery (WAHS) technique involves injecting lidocaine with adrenaline for hand surgical procedures that are done without the use of tourniquets, sedation, regional or general anaesthetic. This is a retrospective review of the first 100 consecutive patients who underwent operations using this technique at our centre. The operations included carpal and cubital tunnel decompression, trapeziectomy, tendon transfer, and tenolysis. A questionnaire adapted from Lalonde’s previous work on wide-awake surgery was used to assess patients’ experiences. Sixty-five percent of the patients responded to the postal questionnaire, the majority reporting a high satisfaction level. Ninety-one percent of responders reported that the operation was less painful or comparable with a procedure at the dentist; 86% would prefer to be wide-awake if they needed to have hand surgery again, and 90% stated they would recommend WAHS to a friend.

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