Scope of Hand Surgery Using Surgeon Administered Local/Regional Anaesthesia

Abstract

Introduction Hand and wrist surgeries are often carried out under local/regional anesthesia. We describe our experience using Surgeon Administered Local/Regional Anaesthesia (SALoRA) without sedation to deliver acute and elective hand surgery anesthesia in a tertiary public hospital in Singapore. This is in comparison to wide awake local anesthesia no tourniquet, which has been increasing in popularity. Methods Retrospective analysis was conducted on all surgeries performed under SALoRA between January 1, 2013, to December 31, 2016, at our institution. Surgeries on areas other than the hand, wrist, forearm, and elbow were excluded. The records were reviewed to analyze the demographics of the patients, profile of cases performed, and their outcomes. Results Of a total of 3016 cases performed, 1994 patients (1275 men; age, 45.78 ± 16 years) fulfilled the inclusion criteria and were available for analysis for the study period. The case distribution was similar to most other published data on day hand surgery cases. Tourniquet was used in 1357 (68%) of cases with an average operation time of 26 ± 19 minutes. Mean tourniquet use was 24 ± 15 minutes. Detailed analysis will be presented. Conclusion This study shows the versatility of SALoRA in delivering hand surgery in a cost-effective manner. A wide spectrum of surgeries in the hand, wrist, forearm, and elbow can be performed using SALoRA safely. This has increased productivity, efficiency, and use of resources. SALoRA has the advantage of a guaranteed and reliable bloodless field, quick turnaround time without the need of extra personnel and resources needed for patient monitoring to abide by Joint Commission International requirements and the potential risk of systemic adrenaline effects.

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“…[2][3][4][5][6] In addition, improved cost and time effectiveness further supports this transition at an institutional level. 2,4,7,8 Although use and familiarity of RLA is increasing, acceptance from patients and health care professionals ultimately determine the success of RLA. There have been few studies that have examined patient-and surgeon-reported experiences in RLA in upper limb surgeries, with few using a validated questionnaire to specifically assess the level of satisfaction of patients undergoing RLA.…”

“…2 3 4 5 6 In addition, improved cost and time effectiveness further supports this transition at an institutional level. 2 4 7 8…”