Total trapeziometacarpal joint arthroplasty using wide awake local anaesthetic no tourniquet

2020 ◽  
pp. 175319342093246
Author(s):  
Lotte P. Larsen ◽  
Torben B. Hansen
Keyword(s):  
Adverse Effects ◽  
Local Anaesthetic ◽  
Joint Arthroplasty ◽  
Patient Acceptance ◽  
Trapeziometacarpal Joint ◽  
Level Of Evidence ◽  
Duration Of Surgery ◽  
Bloodless Field ◽  
Wide Awake ◽  
No Tourniquet

We conducted a descriptive study of 50 consecutive cases of total trapeziometacarpal joint arthroplasty by one surgeon using wide awake local anaesthetic no tourniquet to assess the usefulness and reliability of the anaesthesia, any adverse effects and patient acceptance. No difference was found when comparing the duration of surgery with 50 cases of total trapeziometacarpal joint arthroplasty inserted in a bloodless field under general or regional anaesthesia by the same surgeon. Wide awake local anaesthetic no tourniquet was found to be useful in providing adequate anaesthesia and haemostasis, and to be reliable and safe with no adverse effects. Patient satisfaction was high with 100% willing to repeat. Overall, wide awake local anaesthetic no tourniquet was a satisfactory method of anaesthesia for trapeziometacarpal joint arthroplasty with the potential for significant benefits to both patient and surgeon compared with traditional general anaesthesia and regional block. Level of evidence: II

scholarly journals The efficacy of WALANT technique in Hand Surgery

2021 ◽  
Vol 12 (9) ◽  
pp. 136-141
Author(s):  
Niraj Ranjeet ◽  
Pratyenta Raj Onta ◽  
Krishna Sapkota ◽  
Pabin Thapa ◽  
Upendra jung Thapa ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Hand Surgery ◽  
Dental Procedure ◽  
Duration Of Surgery ◽  
Level 3 ◽  
The Mean ◽  
Procedural Components ◽  
Wide Awake ◽  
No Tourniquet ◽  
Better Than

Background: Nowadays, Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has gained popularity among surgeons because of its use in variety of surgical procedures because it provides excellent hemostasis, eliminating the need of tourniquet, sedation and the risk and cost of general anesthesia. Aims and Objective: In this study, we wanted to evaluate its efficacy and the experiences of the patients and surgeons in different hand surgeries. Materials and Methods: We had 108 patients who underwent various hand surgeries under WALANT technique. Patients and surgeons were requested to fill a questionnaire after the procedure. The procedure was evaluated in terms of the pain compared to a dental procedure, duration of the anesthesia, amount of bleeding and patients’ satisfaction. Results: The mean age of our patients was 42.7 years. A variety of hand surgery was performed in our study. The mean local anaesthetic volume used was 16.5 ml. The Tang grading system was used to evaluate the levels of surgeon’s experience; 75% of surgeons were a Level 2, 18% Level 3 and 7% Level 4. Sixty-four patients experienced WALANT to be less than, 30 patients equivalent to and 8 had more pain compared to a dental procedure. There was a significant correlation between volume of local anesthetic used, duration of surgery and number of procedural components repaired. Both pain and anxiety levels were significantly less intra-operatively and postoperatively as compared to the level at the time of injection. Eighty-seven patients considered it to be better than expected, and would prefer it in the future in case they have to undergo surgery. Conclusion: We observed that our patients were satisfied with their experience on WALANT technique and the surgical procedures, and we recommend the use of this for a variety of hand surgery procedures.

Model-based roentgen stereophotogrammetric analysis of the surface replacement trapeziometacarpal total joint arthroplasty

2016 ◽  
Vol 41 (9) ◽  
pp. 925-929 ◽  
Author(s):  
B. ten Brinke ◽  
N. M. C. Mathijssen ◽  
I. Blom ◽  
R. L. M. Deijkers ◽  
E. M. Ooms ◽  
...  
Keyword(s):  
Survival Rate ◽  
Joint Arthroplasty ◽  
Migration Pattern ◽  
Joint Prosthesis ◽  
Surface Replacement ◽  
Implant Stability ◽  
Trapeziometacarpal Joint ◽  
Level Of Evidence ◽  
Model Based ◽  
Early Migration

The primary aim of this clinical and radiostereometric study was to study the migration pattern of the surface replacement trapeziometacarpal joint prosthesis (SR™TMC, Avanta®, San Diego, CA). The secondary aims were to assess patient-related outcomes and prosthesis survival 5 years after surgery. Ten patients received the prosthesis. Radiostereometric radiographs were obtained 6 weeks, 6 months, 1 year and 5 years post-operatively and were analysed using model-based software. All patients completed DASH and Nelson Hospital scores at these follow-ups. Mean translations varied between 0.0 and 0.5 mm after 5 years. Rotation values could be calculated in six patients and mean rotations varied between −0.3 and 2.3°, although the precision of rotation values seems to be poor. The 5-year survival rate was 80%. Mean pre-operative DASH and Nelson Hospital scores were 53 (SD 14) and 51 (SD 13), respectively. Six months post-operatively, the DASH and Nelson Hospital scores had both significantly improved to 25 (SD 20) and 74 (SD 18) and remained high after 5 years. Implant stability was good 5 years post-operatively, and early migration did not predict implant failure in this study. Level of Evidence: IV.

scholarly journals A protocol for wide awake local anaesthetic no tourniquet (WALANT) hand surgery in the context of the coronavirus disease 2019 (COVID-19) pandemic

The Surgeon ◽  
2020 ◽  
Vol 18 (6) ◽  
pp. e67-e71
Author(s):  
Dorian Hobday ◽  
Ted Welman ◽  
Niamh O'Neill ◽  
Gurjinderpal Singh Pahal
Keyword(s):  
Local Anaesthetic ◽  
Hand Surgery ◽  
Wide Awake ◽  
No Tourniquet

Proximal Interphalangeal Joint Arthroplasty Using the Wide-Awake Local Anesthesia No Tourniquet Technique

Hand ◽  
2021 ◽  
pp. 155894472110635
Author(s):  
Sidharth Sharma ◽  
Jason Ong ◽  
Amit Putti
Keyword(s):  
Local Anesthesia ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Dash Score ◽  
Electronic Patient Records ◽  
Loss Of Function ◽  
Effective Treatment Option ◽  
Wide Awake ◽  
No Tourniquet

Background: Proximal interphalangeal joint (PIPJ) osteoarthritis is a common condition that results in pain, stiffness, and loss of function in the affected hand. Proximal interphalangeal joint arthroplasty is an effective treatment option when conservative methods have failed. The wide-awake local anesthesia no tourniquet (WALANT) technique to perform surgery carries advantages such as lack of tourniquet discomfort, reduces the staffing and costs associated with anesthesia and sedation, and allows faster recovery. We aimed to determine whether the WALANT technique was safe and effective in the context of PIPJ arthroplasty. Methods: Patients were enrolled retrospectively from January 2015 to October 2020 by examining operating theater records and surgeon logbooks. Electronic patient records were examined to obtain patient data. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and Visual Analog Scale (VAS) for pain were sent by post to patients—with a separate DASH and VAS for each digit operated on. Results: Twenty-nine PIPJ arthroplasties were carried out using WALANT technique by 3 different surgeons all using the dorsal approach. All cases were successfully carried out as day-case procedures. There was a significant correlation with increasing VAS and increasing DASH score. Proximal interphalangeal joint arthroplasty improved range of motion from 28.9 ± 5.5° to 79.4 ± 13.3° ( P < .0001). Two cases developed complications related to surgery. Conclusions: Our study is the first to report the use of WALANT to perform PIPJ arthroplasty, and shows comparable results with traditional methods. Larger, multicenter prospective trials are required to determine the efficacy of this technique and to quantify its economical benefit.

Can surgical guidelines minimize complications after Maïa® trapeziometacarpal joint arthroplasty with unconstrained cups?

2017 ◽  
Vol 43 (4) ◽  
pp. 420-425 ◽  
Author(s):  
Pieter Caekebeke ◽  
Joris Duerinckx
Keyword(s):  
Joint Arthroplasty ◽  
Radiological Outcome ◽  
Medium Term ◽  
Trapeziometacarpal Joint ◽  
Level Of Evidence ◽  
Implant Position ◽  
Component Loosening ◽  
Surgical Guidelines ◽  
Cup Position

The most important complications of trapeziometacarpal arthroplasty are dislocation and component loosening. Incorrect cup position is often a contributing factor. Intra-operative guidelines to optimize cup orientation have recently been described. We evaluated the functional and radiological outcome of 50 Maïa® trapeziometacarpal prostheses that were implanted according to these guidelines. The minimum follow-up was 56 months. No constrained cups were used. Functional outcome was good to excellent. No spontaneous dislocations occurred. No radiological signs of loosening were observed. There was one case of premature wear. The survival rate was 96% (95% confidence interval 85 to 99%) at a mean of 65 months, with two prosthesie removed for posttraumatic trapezial fractures. This study shows that correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty. Level of evidence: IV

Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia

2020 ◽  
Vol 45 (8) ◽  
pp. 857-863
Author(s):  
Ruben Dukan ◽  
Elie Krief ◽  
Remy Nizard
Keyword(s):  
Distal Radius ◽  
Local Anaesthesia ◽  
Regional Anaesthesia ◽  
Plate Osteosynthesis ◽  
Clinical Results ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Wide Awake ◽  
No Tourniquet

Surgical fixation of distal radius fractures under local anaesthesia with the patient wide awake allows an intraoperative testing of the fixation stability under active mobilization. We evaluated the feasibility and clinical results of this technique in 45 patients prospectively in two matched comparable groups: wide-awake local anaesthesia no tourniquet and loco-regional anaesthesia. We found that the pain scores during the anaesthetic administration and the surgical procedure were similar in two groups. Ranges of wrist motion and QuickDASH scores were improved significantly in the wide-awake local anaesthesia no tourniquet group at 6 weeks and 3 months and similar at 6 months compared with those receiving loco-regional anaesthesia. Patients in wide-awake local anaesthesia no tourniquet returned to work significantly earlier than the loco-regional anaesthesia group. We conclude that osteosynthesis of distal radius fractures can be safely performed under wide-awake local anaesthesia no tourniquet, leading to no increase in pain level and similar functional outcomes compared with those under loco-regional anaesthesia. Level of evidence: III

scholarly journals 1350 Wide-Awake Local Anaesthetic No Tourniquet (WALANT) Vs General/Regional Anaesthetic for Flexor Tendon Injuries: A Single-Centre, Retrospective Cohort Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Greasley ◽  
P Patel ◽  
G Nolan ◽  
R Bamal ◽  
D Bell
Keyword(s):  
Cohort Study ◽  
Local Anaesthetic ◽  
Regional Anaesthesia ◽  
Retrospective Cohort ◽  
Flexor Tendon ◽  
Tendon Injuries ◽  
Single Centre ◽  
Flexor Tendon Injuries ◽  
Wide Awake ◽  
No Tourniquet

Abstract Aim Flexor tendon repairs are commonly performed under general/regional anaesthesia. Wide-awake local anaesthetic no tourniquet (WALANT) has potential advantages including the ability to test the repair intra-operatively; removal of the risks of general anaesthesia; no aerosol generation, thus reducing COVID-19 transmission risk. An ongoing systematic review identified no comparative studies. This study aimed to compare the functional outcomes and complications of flexor tendon repairs under WALANT and general/regional anaesthetic. Method A single-centre, retrospective cohort study was undertaken (July 2019-August 2020). Consecutive adult patients undergoing flexor tendon repair were included. Exclusion criteria were ≥ 3 injured fingers; concurrent hand fracture; revascularisation; replantation. Data were collected on demographics, injuries, operative technique, and outcomes. Results Overall, 139 patients with 165 injured digits were included. Most (60%) were repaired under general anaesthesia. Local anaesthetic (was used for 46 patients (21 with tourniquet, 25 WALANT). Only 30% (42/139) patients had range of motion data at 6-weeks, dropping to 19% (26/139) at 12-weeks. WALANT patients had fewer ruptures (8% vs 14%), fewer adhesions requiring tenolysis (0% vs 4%) and less complications overall than the general/regional anaesthesia group. The results were not found to be statistically significant. Conclusions The lack of data due to patients not attending follow-up, makes meaningful research on flexor tendon injuries very challenging. This study suggests WALANT may reduce complications but is limited by the inherent bias of a retrospective, non-randomised study, and small numbers. Adequately designed and powered studies are recommended in future to further investigate the potential benefits of wide-awake surgery.

scholarly journals Wide-awake Anesthesia No Tourniquet Trapeziometacarpal Joint Prosthesis Implantation

2018 ◽  
Vol 6 (4) ◽  
pp. e1714 ◽  
Author(s):  
Camillo Theo Müller ◽  
Thierry Christen ◽  
Paul I. Heidekruger ◽  
Jessie Lamouille ◽  
Wassim Raffoul ◽  
...  
Keyword(s):  
Joint Prosthesis ◽  
Trapeziometacarpal Joint ◽  
Prosthesis Implantation ◽  
Wide Awake ◽  
No Tourniquet ◽  
Joint Prosthesis Implantation
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