手部骨折固定术中无止血带宽醒局部麻醉与全身麻醉比较的前瞻性研究

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.06.008

Shalimar Abdullah MS (Ortho), Dip Hand Surgery , Khairul Azmi bin Ghazali MBBS (Ortho & Traumatology) , Elaine Zi Fan Soh MBBS (Ortho & Traumatology) , Jamari Sapuan MD, MS (Ortho) , Parminder Singh Gill MBBS, MS (Ortho) , Chia Hua Lim MD (Ortho & Traumatology)

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引用次数: 0

摘要

目的掌骨或指骨骨折固定术通常在全身麻醉（GA）或区域麻醉下进行，并使用止血带以减少出血。然而，使用止血带会导致术后疼痛和不适。不使用止血带的宽清醒局部麻醉（WALANT）可在患者完全清醒的情况下进行手术，且无需使用止血带，从而可在术中对手术功能进行评估。本研究旨在比较 GA 与 WALANT 在手部骨折固定术中的围手术期参数和临床结果。21名患者在GA下进行了骨折固定，27名患者在WALANT下进行了手术。评估的参数包括生命体征（心率和收缩压）、手术时间、估计失血量、视觉模拟量表以及手臂、肩部和手部快速残疾（QuickDASH）问卷。宽醒局部麻醉无止血带组的手术时间也比一般麻醉组短，但差异不显著。在临床结果方面，WALANT 组在术后 2 小时和 2 周的视觉模拟量表评分明显较低。结论手部骨折固定的宽醒局部麻醉无止血带手术与GA相比，具有相似的镇痛效果和可比的QuickDASH评分（术后3个月除外）。

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A Prospective Study Comparing Wide-Awake Local Anesthesia No Tourniquet Versus General Anesthesia in Hand Fracture Fixation

Purpose

Fixation of metacarpal or phalanx bone fractures is usually performed under general anesthesia (GA) or regional anesthesia and with the use of a tourniquet to minimize bleeding. However, the use of tourniquet causes pain and discomfort after surgery. Wide-awake local anesthesia no tourniquet (WALANT) enables the surgery to be performed with the patient fully awake and without a tourniquet, which allows intraoperative assessment of function during surgery. This study aims to compare the perioperative parameters and clinical outcomes between GA versus WALANT in hand fracture fixations.

Methods

Forty-eight patients with hand fractures were recruited over a period of 15 months. Twenty-one patients had undergone fracture fixation under GA, whereas another 27 patients had the surgery under WALANT. Parameters including vital signs (heart rate and systolic blood pressure), surgery duration, estimated blood loss, visual analog scale, and quick disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire were evaluated.

Results

Wide-awake local anesthesia no tourniquet group had significantly higher systolic blood pressure values and higher estimated blood less than GA group. Wide-awake local anesthesia no tourniquet group also documented shorter surgical time compared with GA group, but the difference was not significant. In terms of clinical outcomes, WALANT group recorded significantly lower visual analog scale score at 2 hours and 2 weeks postsurgery. However, WALANT has a comparable QuickDASH score with GA group except at 3 months postsurgery.

Conclusions

Wide-awake local anesthesia no tourniquet surgery for hand fracture fixation provides a similar analgesic effect and comparable QuickDASH score except at 3 months postsurgery compared with GA.