The effect of wide-awake anesthesia, intravenous regional anesthesia, and infraclavicular brachial plexus block on cost and clinical scores of patients undergoing hand surgery

Orman, Osman; Tugce, Yeniocak; Baydar, Mehmet; Şencan, Atilla; İpteç, Murat; Öztürk, Kahraman

doi:10.1016/j.hansur.2021.03.013

Cited by 10 publications

(3 citation statements)

References 26 publications

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“…Na et al similarly observed shorter duration of local anaesthetic in the supraorbital scalp as compared to that of the frontotemporal scalp 64 . Nerve blocks take more time than LIA due to the thicker perineurium of larger nerves 57 , 58 , 65 . The reviewed studies suggest digital nerves may have had longer latency time than small branches of volar forearm cutaneous nerves 20 , 21 .…”

Section: Discussionmentioning

confidence: 99%

How long to wait after local infiltration anaesthesia: systematic review

Bajwa,

Bashir,

Bajwa

et al. 2023

BJS Open

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Background Conflicting evidence exists regarding the optimal waiting time for stable analgesic and vasoconstrictive effects after local infiltration of lidocaine with epinephrine. An objective review is needed to dispel surgical dogma. Methods This systematic review (PROSPERO ID: CRD42022362414) included RCTs and prospective cohort studies. Primary outcomes were (1) onset of analgesia and (2) onset of stable hypoperfusion, assessed directly, or measured indirectly using perfusion imaging. Other data extracted include waiting strategies, means of outcome assessment, anaesthetic concentrations, volume/endpoint of infiltration, and injection sites. Methodological quality was evaluated using the Cochrane risk-of-bias tool for randomized trials. Articles describing waiting strategies were critically appraised by the Joanna Briggs Institute tools. Results Twenty-four articles were analysed, comprising 1013 participants. Ten investigated analgesia onset. Their pooled mean was 2.1 min (range 0.4–9.0 min). This varied with anatomic site and targeted nerve diameter. Fourteen articles investigated onset of stable hypoperfusion. Four observed bleeding intraoperatively, finding the minimum time to hypoperfusion at 7.0 min in the eyelid skin and 25.0 min in the upper limb. The ten remaining studies used perfusion imaging, reporting a wide range of results (0.0–30.0 min) due to differences in anatomic sites and depth, resolution and artefacts. Studies using near-infrared reflectance spectroscopy and hyperspectral imaging correlated with clinical observations. Thirteen articles discussed waiting strategies, seven relating to large-volume tumescent local infiltration anaesthesia. Different waiting strategies exist for emergency, arthroscopic and cosmetic surgeries, according to the degree of hypoperfusion required. In tumescent liposuction, waiting 10.0–60.0 min is the norm. Conclusion Current literature suggests that around 2 min are required for most patients to achieve complete analgesia in all sites and with all anaesthesia concentrations. Waiting around 7 min in eyelids and at least 25 min in other regions results in optimal hypoperfusion. The strategies discussed inform decisions of when and how long to wait.

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Section: Discussionmentioning

confidence: 99%

How long to wait after local infiltration anaesthesia: systematic review

Bajwa,

Bashir,

Bajwa

et al. 2023

BJS Open

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“…[6,7] It has been reported in studies on hand and wrist surgery that the development of new and more local regional anesthesia methods instead of TA methods reduces the length of stay in the hospital and reduces the operating costs. [11][12][13] However, information on the use of WALANT in foot and ankle surgery is limited. In our study, it is demonstrated that this method can be applied safely, and the costs are reduced by 20.3% compared to spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Metatarsal osteotomy for hallux valgus under wide-awake local anesthesia with no tourniquet technique

Pamuk¹

2022

Jt Dis Relat Surg

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Objectives The issue of performing a hallux valgus operation with the wide-awake local anesthesia with no tourniquet (WALANT) technique has not been evaluated before. The objective of this study was to compare the clinical results of patients who underwent the WALANT technique during hallux valgus operation and patients who underwent the procedure with traditional anesthesia (TA). Patients and methods In this cross-sectional, retrospective study, 34 patients (17 males, 17 females; mean age: 46.1±8.3 years; range, 36 to 62 years) who underwent first metatarsal osteotomy with the diagnosis of hallux valgus disease at the orthopedics and traumatology department of the Private Silivri Anadolu Hospital between November 1, 2018, and June 1, 2020, were divided into two groups according to the surgical approach determined by patient choice: the WALANT group and the TA group. Demographic characteristics, Visual Analog Scale (VAS) scores for pain and anxiety, postoperative satisfaction levels, and complications were recorded. Results There was no significant difference between the groups in terms of demographic characteristics. The VAS pain score during needle insertion was significantly higher in the WALANT group compared to the TA group (p<0.001). Conversely, the VAS anxiety score was significantly higher in the WALANT group compared to the TA group (p<0.001). The median follow-up time was 5.4 months (interquartile range, 5-6 months). Conclusion This is the first study demonstrating that adequate anesthetic efficacy can be achieved with the WALANT technique for the hallux valgus operation. Acceptable pain scores can be achieved with this technique, and costs are reduced.

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“…The administration of sedatives has many advantages which usually makes the patient feels comfortable with an associated short-term memory loss which erases unpleasant memories. However, if these drugs are misused or abused, they can suppress the cardiovascular and respiratory systems, lower core temperature, or severely lower patients' blood pressure [5]. Moreover, some patients are not suitable for sedation, for instance, obstetric and elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Listening Music in Reducing Anxiety for Regional Anesthesia Cases

Mrba¹,

Mb²,

Mf³

2021

Preprint

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In this study, the effects of music therapy on anxiety for patients undergoing regional anaesthesia in an operating room was succinctly investigated. This investigation was largely based on the adapted Hospital Anxiety and Depression Score (HADS) and Spielberger State-Trait Anxiety Inventory (STAI-S), of patients undergoing regional anaesthesia in an operating room. A randomized control trial was performed on 90 patients due for surgery. The selected patients for regional anaesthesia were allocated to either the music therapy group who listened to music using headphones for the entire surgery or the no-treatment control group. Based on the findings, it has been conclusively demonstrated that music can decrease the patient's anxiety level. According to the socio-demographic evaluation, elderly patients have the highest stress hormones levels when compared to young patients. Although elderly patients are more likely to choose religious songs to help them relax, cortisol analysis revealed an increase in cortisol levels among the elderly compared with younger patients. As a result, music is especially important to be delivered to elderly patients. Nonetheless, there is no restriction against administering music to elderly patients because evidence from the Hospital Anxiety and Depression Score (HADS) and State-Trait Anxiety Inventory (STAI-S) has shown that music helps to shift their attention away from pain and complications and makes them feel tranquil. Similarly, the HADS and modified Spielberger STAI (STAI-S) analyses demonstrate a substantial outcome for both groups, with respondents responding positively. The study found that listening to music during regional anaesthesia might help people feel less worried.

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The effect of wide-awake anesthesia, intravenous regional anesthesia, and infraclavicular brachial plexus block on cost and clinical scores of patients undergoing hand surgery

Cited by 10 publications

References 26 publications

How long to wait after local infiltration anaesthesia: systematic review

How long to wait after local infiltration anaesthesia: systematic review

Metatarsal osteotomy for hallux valgus under wide-awake local anesthesia with no tourniquet technique

Listening Music in Reducing Anxiety for Regional Anesthesia Cases

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