A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia

Yen, Cheng-Yo; Ma, Ching-Hou; Wu, Cheng‐Hsien; Yang, Shih-Chieh; Jou, I‐Ming; Tu, Yuan‐Kun

doi:10.1186/s12891-020-03482-0

Cited by 8 publications

(21 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Following this, 120 full-text articles were reviewed, and 14 met the inclusion criteria. 12,21,27–38 Seven of these 14 studies were randomized controlled trials (RCTs), 12,21,27,29–31,37 and 7 were nonrandomized studies, 28,32–36,38 including 3 prospective observational studies (POSTs) 28,32,38 and 4 retrospective cohort studies (RCSs). 33–36…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review on Long-Term Postsurgical Pain Outcomes; What Is the Effect of Upper Extremity Regional Anesthesia?

Droog,

Walbeehm,

Konijn

et al. 2023

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND: Chronic pain is a recognized complication of surgery, and it has been hypothesized that regional anesthesia might reduce the risk of development of chronic pain after upper extremity surgery. METHODS: A systematic literature review was performed to assess whether in patients undergoing elective upper extremity surgery (P), regional anesthesia (I), compared to general anesthesia (C), would result in lower long-term (>3 months) postoperative pain intensity (O). We included randomized and nonrandomized controlled trials (RCTs). Our primary outcome was numerical rating score or visual analogue scale for pain, at >3 months postoperatively. The Embase, Medline ALL, Web of Science Core Collections, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for all reports assessing pain at >3 months after upper extremity surgery under general versus regional anesthesia. Secondary outcomes were: opioid prescription filling, complex regional pain syndrome (CRPS) incidence, the Mayo Wrist Score (MWS), and scores on the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Quality (or certainty) of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Risk-of-bias was assessed using the Cochrane tool for randomized trials (RoB 2.0) and nonrandomized trials (ROBINS-I). RESULTS: This review included 14 studies, comprising 7 RCTs and 7 nonrandomized studies. Six of the 7 studies (4 RCTs, N = 273; 2 nonrandomized studies, N = 305) using a pain score, our primary outcome, report comparable long-term postoperative pain scores after regional and general anesthesia. Six of the 7 studies using our secondary outcomes report comparable long-term outcomes in terms of opioid prescription filling (2 retrospective cohort studies [RCSs], N = 89,256), CRPS incidence (1 RCT, N = 301), MWS (1 RCT and 1 RCS, N = 215), and DASH score (1 RCT, N = 36). Comparable outcomes were reported in all 7 RCTs (N = 778) and in 5 of the 7 nonrandomized studies, comprising 5 RCSs (N = 89,608). Two prospective observational studies (POSTs), comprising 279 patients, report a statistically significant difference in outcomes, with less pain and better DASH scores after brachial plexus anesthesia. All 14 studies provided moderate to very low certainty evidence, and there was a serious risk of bias due to confounding bias in 5 of the 7 nonrandomized studies (N = 631). CONCLUSIONS: The results of this review indicate that upper extremity regional anesthesia, compared to general anesthesia, is unlikely to change pain intensity at >3 months postoperatively.

show abstract

Section: Resultsmentioning

confidence: 99%

A Systematic Review on Long-Term Postsurgical Pain Outcomes; What Is the Effect of Upper Extremity Regional Anesthesia?

Droog,

Walbeehm,

Konijn

et al. 2023

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…Finally, according to the cost of hand surgery, WALANT reduces the cost because preoperative tests are not necessary, anesthesiologic team, medication or monitoring are not needed, and hospitalization care time is decreased [37] . Lin et al(2021) estimated that cost of treatment for internal fixation of metacarpal fracture is lower than 287 USD per cases in WALANT instead GA [38] .…”

Section: Discussionmentioning

confidence: 99%

Wide Awake Local Anesthesia No Tourniquet (WALANT) Versus Bier’s Block, in Internal Fixation of Unstable Metacarpal and Phalangeal Fractures of the Hand: A Comparative Study

Kastanis

Pantouvaki

Kapsetakis

et al. 2023

ijirms

View full text Add to dashboard Cite

Hand fractures are a common injury in emergency department, and the majority of these are stable injuries that can be treated conservatively with excellent functional results. When respective injuries are characterized as unstable, surgical reduction and stabilization is necessary. Generally, these operations are conducted under regional or general anesthesia to avoid pain and tourniquet for bloodless surgical fields. Wide Awake local anesthesia no tourniquet (WALANT) procedure is described as a local injection of anesthetic agent and epinephrine without tourniquet application, with scope to allow local anesthesia without other sedation and at the same time hemostasis. The purpose of the study is to compare the functional assessment of the hand function during a period of three months after surgical intervention for unstable metacarpal and phalangeal fractures under WALANT versus Biers block. Material &Methods: Between May 2021 to October 2022, 43 patients with unstable metacarpal and phalangeal fractures underwent open reduction and internal fixation, 21 cases with Biers block(BB) anesthesia and rest with WALANT technique. Metacarpal fractures appeared in 29 cases and phalangeal fractures in 14 patients. Patients were operated within the first week from the injury. According to implants they employed locking plates, screws and Kirschner wires in two groups. Results: At three months postoperatively, Quick Dash Score is better in WALANT group while patients’ satisfaction does not differ between two groups. In WALANT group immediate postoperative median VA Score appeared 2/10, while in the Biers block group appeared 6/10. Patients which underwent WALANT technique were discharged on the same day after operation, while the patients with regional anesthesia the next postoperative day. Mean duration of analgesic use was sorter in WALANT group (2,3 days) than in BB group (5,7 days). Conclusion: Οbjective of surgical treatment of unstable hand fractures (metacarpal-phalangeal) is early mobilization and enhance hand functionality to avoid stiffness and tendon adhesions. Wide Awake local anesthesia no tourniquet technique is an alternative sedative procedure which immediately offers postoperative numerous advantages (low-cost technique, no complication from tourniquet, decrease sensation of intra or postoperative pain) compared with Bier’s block anesthesia. Based on our results we believe that WALANT technique offers many benefits in surgical treatment of hand fractures and is suggested as first choice anesthesiologist procedure.

show abstract

“…Since the preoperative testing, anesthesia fee, and hospitalization are all eliminated, higher cost savings are associated with WALANT technique [ 7 , 9 ]. Instead of GA, WALANT surgery for internal metacarpal fixation demonstrated savings of approximately 287 USD per case (Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, the literature has proven that epinephrine is safe in hand surgery, even on the end of the finger [ 3 – 6 ]. In addition to safety, several studies have approved the cost-effectiveness of WALANT [ 7 – 9 ]. Most hand operations can be performed with WALANT today.…”

Section: Introductionmentioning

confidence: 99%

Plate osteosynthesis of single metacarpal fracture: WALANT technique is a cost-effective approach to reduce postoperative pain and discomfort in contrast to general anesthesia and wrist block

Lin

Chen

et al. 2021

BMC Surg

View full text Add to dashboard Cite

Background The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures. Methods We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment. Results A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery. Conclusions The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.

show abstract

A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia

Cited by 8 publications

References 23 publications

A Systematic Review on Long-Term Postsurgical Pain Outcomes; What Is the Effect of Upper Extremity Regional Anesthesia?

A Systematic Review on Long-Term Postsurgical Pain Outcomes; What Is the Effect of Upper Extremity Regional Anesthesia?

Wide Awake Local Anesthesia No Tourniquet (WALANT) Versus Bier’s Block, in Internal Fixation of Unstable Metacarpal and Phalangeal Fractures of the Hand: A Comparative Study

Plate osteosynthesis of single metacarpal fracture: WALANT technique is a cost-effective approach to reduce postoperative pain and discomfort in contrast to general anesthesia and wrist block

Contact Info

Product

Resources

About