Anaesthesia Conduction
Conditions
Keywords
WALANT (Wide-Awake Local Anesthesia No Tourniquet ), Regional Anesthesia, Hand flexor Tendon Repair, Supra-clavicular brachial plexus block, Hand surgery
Brief summary
The study trying to fined out the best anaesthesia technique for hand flexor procedures which provide efficient anaesthesia while providing adequate surgical field exposure & less blood loss
Detailed description
The current study compared patients scheduled for hand surgical procedures using wide awake local anaesthetic infiltration to those receiving supra-clavicular brachial plexus block. the comparison including adequacy of pain control, blood loss, patient satisfaction, time & skills needed to provide aesthetic technique.
Interventions
OTHERlocal anaesthesia infiltration
Infiltration of 150 mg of lidocaine solution per ray at site of surgical incision for flexor tendon repair in the palm, the 2 proximal & distal phalanges
OTHERbrachial plexus block
ultrasound-guided infiltration of local aesthetics around brachial plexus trunks & divisions
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
For those assessing & providing postoperative analgesia (secondary outcome)they are blind to the used anaesthetic technique .
Intervention model description
patients were allocated to one of two groups. one received WALANT (with no tourniqut) & the other (control) group received supra-clavicular block (with tourniquet). Groups were compared for anaesthesia efficiency
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participants were included if they were to be scheduled for Flexor tendon repair (Interventions involving flexor tendons of the wrist (Flexor Carpi Ulnaris (FCU), Flexor Carpi Radialis (FCR), and/or Palmaris Longus PL), fingers (flexor digitorum Profundus FDP and/or Flexor Digitorum Superficialis FDS) and thumb (Flexor Pollicis Longus FPL)), aged 18 years or over & of ASA physical status I or II.
Exclusion criteria
* Participants were excluded if they were (American society of Anaesthesia) ASA physical status III or IV, refusal of anaesthetic procedure or refuse to participation in the study, documented hypersensitivity to lidocaine, compromised peripheral circulation (Patients with previous vascular injury, vasculitis, Buerger's disease, and scleroderma), evidence of infection at injection site, patients with ischemic heart disease or psychiatric illness and patients with concomitant injuries that needed further operative procedure under general anesthesia or spinal anesthesia.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intra-operative pain score | duration of operation | pain assessment during operation at the following moments: before the injection, during injections , during the incision , during gentle manipulation , during aggressive manipulation and during wound closure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood loss | duration of operation | calculated based upon the number and degree of soaking of swabs used in the operation and the amount in a suction container in the operation room. |
| intra-operative preserved motor power intraoperative | duration of operation | surgeon test the motor power after repair of the affected tendon |
| anaesthesia induction time | duration of operation | the time taken to provide anesthesia |
| patient satisfaction | 12 hours post operative | was measured and recorded using five-point Likert scale\[25\] (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied) with checklist and a closed-ended question If you were to undergo this surgery again, would you choose the same type of anaesthesia? YES or NO |
| postoperative pain scores | 12 hours postoperatively | numeric pain rating scale (NRS)A respondent selected a whole number (0- 10 integers) that best reflects the intensity of his pain, 0-10 was recorded by a blinded investigator at 2, 4, 6, 8, 10, 12 hours postoperatively, time of 1st call for postoperative analgesia was recorded, patients received 25 mg pethidine IV if the NRS pain exceeds 3, the dose was repeated on patient's demand with 2 hours minimal time interval between doses, total analgesic dose required in the 1st twelve hours postoperatively |
| operative time | duration of operation | time from skin incision till last suture applied for wound closure |
Countries
Egypt
Outcome results
None listed