使用无止血带宽醒局部麻醉与使用止血带局部麻醉进行扳机指松解术:系统回顾与元分析》。

IF 1.8 Q2 ORTHOPEDICS
HAND Pub Date : 2025-06-01 Epub Date: 2024-01-20 DOI:10.1177/15589447231222517
Tal Levit, Declan C T Lavoie, Emily Dunn, Lucas Gallo, Achilles Thoma
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引用次数: 0

摘要

扳机指松解术(TFR)是一种常见的手部手术,历来使用止血带进行。最近,不使用止血带的宽醒局部麻醉(WALANT)因其表面上的优势,如改善患者疼痛、提高满意度、降低并发症发生率和降低成本等,受到越来越多人的青睐。本系统性综述比较了 WALANT 与止血带局部麻醉(LAWT)治疗 TFR 的效果。检索了 MEDLINE、Embase、CINAHL、Web of Science、Cochrane Central Register of Controlled Trials 和 ClinicalTrials.gov。纳入了所有评估成人 TFR 的英文同行评审随机研究和观察性研究。证据质量采用建议、评估、发展和评价分级(GRADE)系统进行评估。共确定了 11 项研究(4 项随机对照试验,7 项观察性研究),包括 1233 名患者。在 WALANT 组中,注射时的疼痛在统计学上无显著降低(平均差异 [MD]:-1.69 点,95% 置信区间 [CI] = -4.14 至 0.76,P = .18),在 2 项研究中,术后疼痛在统计学上有所降低。患者和医生的满意度在 WALANT 中较高,镇痛剂的使用率较低。在功能结果或不良事件发生率方面,组间无明显差异。WALANT 与 LAWT 相比,术前时间更长(MD:26.43 分钟,95% CI = 15.36 到 37.51,P < .01),手术时间相似(MD:-0.59 分钟,95% CI = -2.37 到 1.20,P = .52),术后时间更短(MD:-27.72 分钟,95% CI = -36.95 到 -18.48,P < .01),成本更低(MD:-52.2%,95% CI = -79.9% 到 -24.5%)。这些结果的 GRADE 证据确定性从很低到很低不等。由于纳入的研究存在中度至高度偏倚风险,本系统综述并未证实WALANT在TFR方面优于LAWT;必须进一步开展稳健的试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trigger Finger Release Using Wide-Awake Local Anesthesia No Tourniquet Versus Local Anesthesia With a Tourniquet: A Systematic Review and Meta-analysis.

Trigger finger release (TFR) is a common hand surgery, historically performed using a tourniquet. Recently, wide-awake local anesthesia no tourniquet (WALANT) has gained popularity due to ostensible advantages such as improved patient pain, satisfaction, lower rate of complications, and decreased cost. This systematic review compares outcomes of WALANT for TFR with local anesthesia with a tourniquet (LAWT). MEDLINE, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched. All English-language peer-reviewed randomized and observational studies assessing TFR in adults were included. Quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Eleven studies (4 randomized controlled trials, 7 observational) including 1233 patients were identified. In the WALANT group, pain on injection was statistically nonsignificantly lower (mean difference [MD]: -1.69 points, 95% confidence interval [CI] = -4.14 to 0.76, P = .18) and postoperative pain was statistically lower in 2 studies. Patient and physician satisfaction were higher and analgesic use was lower in WALANT. There were no significant differences between groups for functional outcomes or rates of adverse events. Preoperative time was longer (MD: 26.43 minutes, 95% CI = 15.36 to 37.51, P < .01), operative time similar (MD: -0.59 minutes, 95% CI = -2.37 to 1.20, P = .52), postoperative time shorter (MD: -27.72 minutes, 95% CI = -36.95 to -18.48, P < .01), and cost lower (MD: -52.2%, 95% CI = -79.9% to -24.5%) in WALANT versus LAWT. The GRADE certainty of evidence of these results ranges from very low to low. This systematic review does not confirm superiority of WALANT over LAWT for TFR due to moderate to high risk of bias of included studies; further robust trials must be conducted.

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来源期刊
HAND
HAND Medicine-Surgery
CiteScore
3.30
自引率
0.00%
发文量
209
期刊介绍: HAND is the official journal of the American Association for Hand Surgery and is a peer-reviewed journal featuring articles written by clinicians worldwide presenting current research and clinical work in the field of hand surgery. It features articles related to all aspects of hand and upper extremity surgery and the post operative care and rehabilitation of the hand.
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