Network meta-analysis comparing WALANT, locoregional, local and general anesthesia techniques in carpal tunnel release.

IF 4.3 2区医学 Q1 ORTHOPEDICS

Efort Open Reviews Pub Date : 2025-01-03 Print Date: 2025-01-01 DOI:10.1530/EOR-2024-0014

Laurentiu-Cosmin Focsa, Pierre-Alban Bouché, Thomas Apard, Daphné Querel, Marc-Antoine Rousseau, Jules Descamps

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引用次数: 0

Abstract

Purpose: To compare anesthesia techniques (WALANT (wide-awake anesthesia no tourniquet), locoregional anesthesia, local anesthesia with tourniquet or sedation) for carpal tunnel release (CTR).

Methods: A comprehensive literature search was conducted on PubMed, MEDLINE, Embase and the Cochrane Library up to May 2023. Two independent reviewers selected the studies and extracted the data. The primary outcomes included the pain experienced at the moment of anesthesia and during the surgery and the mean morphine equivalents (MME) administered following the surgery and overall patient satisfaction. Our secondary outcomes consisted of the mean room occupancy time and the mean duration of the procedure, followed by the complication rate. The review process was conducted according to PRISMA guidelines.

Results: A total of 3166 studies were identified, which included 23 studies comparing various anesthesia types and 28,748 CTR surgeries. The WALANT group experienced significantly lower pain levels during anesthesia (-2.67 (95% CIs: 0.12-4.99)) and surgery (-2.04 (95% CIs: 0.08-4.07)) compared to the local anesthesia group. There was no difference in the use of MME for pain relief among different anesthesia techniques. Satisfaction rates were comparable, but WALANT exhibited the highest probability for utmost satisfaction. The mean room occupancy time was lower in patients receiving local anesthesia compared with when sedation was added, with a mean difference of -27.16 (95% CIs: -52.03 to -1.85).

Conclusions: The WALANT technique for CTR reported better outcomes for pain (during anesthesia and surgery), higher satisfaction and low probability to expand the operating room occupancy time.

Level of evidence: Level II of evidence.

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网络荟萃分析比较WALANT、局部、局部和全身麻醉技术在腕管释放中的应用。

目的：比较不同麻醉方式（无止血带全醒麻醉）、局部麻醉、局部麻醉加止血带或镇静)对腕管释放（CTR）的影响。方法：检索截至2023年5月PubMed、MEDLINE、Embase和Cochrane图书馆的文献。两名独立的审稿人选择研究并提取数据。主要结果包括麻醉时和手术期间的疼痛、手术后给予的平均吗啡当量（MME）和总体患者满意度。我们的次要结果包括平均房间占用时间和平均手术时间，其次是并发症发生率。审查过程是根据PRISMA准则进行的。结果：共纳入3166项研究，其中23项研究比较不同麻醉方式和28748例CTR手术。与局麻组相比，WALANT组在麻醉期间（-2.67 (95% ci: 0.12-4.99)）和手术期间（-2.04 (95% ci: 0.08-4.07)）的疼痛水平显著降低。不同麻醉方法对MME的镇痛效果无差异。满意度是可比较的，但WALANT表现出最大满意度的最高可能性。局麻组患者的平均入住时间较加镇静组低，平均差值为-27.16 （95% ci: -52.03 ~ -1.85）。结论：WALANT技术用于CTR治疗疼痛（麻醉和手术期间）的效果更好，满意度更高，延长手术室占用时间的可能性较小。证据等级：二级证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Efort Open Reviews Medicine-Orthopedics and Sports Medicine

CiteScore

6.60

自引率

2.90%

发文量

101

审稿时长

13 weeks

期刊介绍： EFORT Open Reviews publishes high-quality instructional review articles across the whole field of orthopaedics and traumatology. Commissioned, peer-reviewed articles from international experts summarize current knowledge and practice in orthopaedics, with the aim of providing systematic coverage of the field. All articles undergo rigorous scientific editing to ensure the highest standards of accuracy and clarity. This continuously published online journal is fully open access and will provide integrated CME. It is an authoritative resource for educating trainees and supports practising orthopaedic surgeons in keeping informed about the latest clinical and scientific advances. One print issue containing a selection of papers from the journal will be published each year to coincide with the EFORT Annual Congress. EFORT Open Reviews is the official journal of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and is published in partnership with The British Editorial Society of Bone & Joint Surgery.