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- Title
Comparison between wide-awake local anaesthesia no tourniquet surgery and traditional local anaesthesia surgery for limb operations.
- Authors
Ng, Sing Yuen; Yip, Emily Ka Yan
- Abstract
Background: In traditional local anaesthesia surgeries, tourniquets are used to reduce blood loss. However, it may induce tourniquet pain. If a long tourniquet time is anticipated, regional or general anaesthesia may be required. Wide-awake local anaesthesia no tourniquet (WALANT) surgery suggests blood loss can be controlled by the use of adrenaline instead of a tourniquet. This study aims to investigate the difference in patient's pain perception, satisfaction and hemostasis control between two groups of patients, the WALANT group, who underwent WALANT surgery, and the traditional group, who underwent traditional local anaesthesia with tourniquet surgery. Methods: This was a prospective cohort study of patients who underwent common orthopaedic local anaesthesia surgeries in a regional hospital between January 2020 and December 2020. Operations were performed by two groups of surgeons: WALANT group and traditional group. Data were collected via questionnaires which included patients' demographics, diagnosis and operation type, surgeon experience, dosage and type of local anaesthesia use, tourniquet use, operation time, hemostasis status, difficulty of operation, patient's pain perception (pain during LA injection, wound site pain during operation, tourniquet pain, post-operative pain) and satisfaction. The data were analysed by Mann–Whitney U test with SPSS. Results: A total of 143 questionnaires were collected. The WALANT group suffered from less wound site pain during operation (p = 0.008), less tourniquet pain (p < 0.001) and less post-operative pain (p < 0.001). WALANT group had a longer operation time (p = 0.002). Both the traditional group and WALANT group were commented to have good haemostasis with a median score of 1 and 2, respectively, although the difference in hemostasis control value was significant (p < 0.001). Conclusion: WALANT surgery was safe and could achieve similar hemostasis with no limitation of tourniquet time and could significantly reduce post-operative pain compared with traditional local anaesthesia with tourniquet use. Level of evidence: Level II.
- Subjects
HONG Kong (China); EXTREMITIES (Anatomy) -- Surgery; TOURNIQUETS; LIDOCAINE; PAIN; INJECTIONS; ORTHOPEDIC surgery; ADRENALINE; TIME; WORK; PATIENT satisfaction; SURGICAL hemostasis; MANN Whitney U Test; TREATMENT effectiveness; RANDOMIZED controlled trials; COMPARATIVE studies; SEVERITY of illness index; PUBLIC hospitals; QUESTIONNAIRES; PHENTOLAMINE; CHI-squared test; EXPERIENTIAL learning; DATA analysis software; LONGITUDINAL method; LOCAL anesthetics; POSTOPERATIVE pain
- Publication
Journal of Orthopaedics, Trauma & Rehabilitation, 2023, Vol 30, Issue 2, p193
- ISSN
2210-4917
- Publication type
Article
- DOI
10.1177/22104917221144706