WALANT versus intravenous regional anesthesia for carpal tunnel syndrome: a randomized clinical trial

ABSTRACT BACKGROUND: There are several anesthetic techniques for surgical treatment of carpal tunnel syndrome (CTS). Results from this surgery using the "wide awake local anesthesia no tourniquet" (WALANT) technique have been described. However, there is no conclusive evidence regarding the effectiveness of the WALANT technique, compared with the usual techniques. OBJECTIVE: To evaluate the effectiveness of the WALANT technique, compared with intravenous regional anesthesia (IVRA; Bier's block), for surgical treatment of CTS. DESIGN AND SETTING: Randomized clinical trial, conducted at Hospital Alvorada Moema and the Discipline of Hand Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: Seventy-eight patients were included. The primary outcome was measurement of perioperative pain through a visual analogue scale (VAS). The secondary outcomes were the Boston Questionnaire score, Hospital Anxiety and Depression Scale (HADS) score, need for use of analgesics, operating room times, remission of paresthesia, failures and complications. RESULTS: The WALANT technique (n = 40) proved to be superior to IVRA (n = 38), especially for controlling intraoperative pain (0.11 versus 3.7 cm; P < 0.001) and postoperative pain (0.6 versus 3.9 cm; P < 0.001). Patients spent more time in the operating room in the IVRA group (59.5 versus 46 minutes; P < 0.01) and needed to use more analgesics (10.8 versus 5.7 dipyrone tablets; P = 0.02). Five IVRA procedures failed (5 versus 0; P = 0.06). CONCLUSIONS: The WALANT technique is more effective than IVRA for CTS surgery.

The impact of Verapamil addition to Ketamine and Lidocaine Intravenous regional Anesthesia: A Randomized controlled study.

Background: The use of adjuncts along with Lidocaine during intravenous regional anesthesia (IVRA) decreases tourniquet pain and prolongs post-operative analgesia. Addition of ketamine reduces the time for onset of block, delays the onset of tourniquet pain and reduces postoperative analgesic requirement. Verapamil potentiates the effect of neuromuscular blocking agents. This study was designed to evaluate the effect of adding Verapamil (2.5 mg) to Lidocaine plus Ketamine (0.5 mg/kg) in comparison with lidocaine plus ketamine IVRA. Materials and methods: Hundred and twenty patients, aged 18–50 years, ASA physical status I and II undergoing elective hand or forearm surgery under Bier’s Block lasting one to one and half hours were included in this double-blinded, randomized and controlled study. Patients were divided into two groups of 60 patients each. Group- I (control group) received 40 ml of 0.5% Lidocaine plus ketamine (0.5 mg/kg) and Group- II received an addition of 2.5 mg of verapamil IVRA. Sensory and motor block onset and recovery time were noted. After the tourniquet deflation: pain, sedation values, time to first analgesic requirement and side effects were evaluated over a period of 12 hours. Results: Significant postoperative hemodynamic changes, sedation score, pain score and delayed first request for analgesia was observed in-group II when compared to group I. Sensory and motor block characteristics were significant in-group II as against group I. The side effect profile of verapamil (2.5mg) was minimal with a few episodes of hypotension and bradycardia, which were clinically managed by ephedrine and atropine respectively.

Study of Efficacy of Tramadol as an Adjuvant to Lignocaine in Intravenous Regional Anesthesia at a Tertiary Care Teaching Centre

Introduction: Tramadol is a central analgesic with an opioid agonistic activity with some selectivity for µ-receptors. Several studies showed that tramadol is beneficial as an additive to local anesthetics in different regional nerve blocks including infiltration, caudal block, brachial plexus block and IVRA. However, the existing data on its role as an additive for IVRA are conflicting. Therefore, a prospective, randomized controlled trial was conducted to determine efficacy of Tramadol (100mg) as an intra-operative, post-operative and pre-emptive analgesic as an adjuvant to lignocaine in IVRA. Materials and Methods: Present study was   carried   out   in   80   patients   undergoing   upper arm orthopedic surgery at Sharda Hospital, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India. All patients selected were planned for forearm surgeries, of ASA Grade I or II, aged 16-60 years. Patients received 0.5% lignocaine 40 ml in one group and we added Tramadol 100 mg in the other group. All the patients were monitored for onset of effect, quality of anesthesia, post op analgesia after deflation of tourniquet, time of first analgesic drug and number of analgesic drug required in first 24 hrs. Results: Onset of sensory analgesia was significantly earlier in group B (59.7±23.8 sec v/s 196.3±42.7) while onset of motor paralysis was similar in both groups. The post-operative analgesia was significantly longer in group B (304.7 ± 87.9 mins) then group A (12.6 ± 5.1 mins). Accordingly the number of analgesics consumed in post-operative first 24 hours was significantly less in group B (1.2±0.6) then group A (2.9±0.8). Conclusion: Tramadol has favorable effects as an adjuvant to lignocaine for IVRA. Tramadol substantially shortens the onset of sensory block, improves patient’s tolerance of tourniquet, prolongs the duration of analgesia after deflation of tourniquet and reduces the postoperative analgesic consumption.