Application of wide awake local anesthesia no tourniquet in wrist arthroscopy / 中华创伤骨科杂志

ABSTRACT

Objective To explore the effectiveness of wide awake local anesthesia no tourniquet (WALANT) in arthroscopy for diagnosis and treatment of wrist injuries and conditions.Methods Between January 2012 and January 2016,WALANT approach was used in wrist arthroscopy for 22 patients with wrist injury or condition at Department of Hand Surgery,Beijing Jishuitan Hospital.They were 10 males and 12 females,aged from 19 to 56 years(average,34 years).Arthroscopic exploration was conducted in 7 cases,arthroscopic synovectomy in 6,dorsal wrist ganglionectomy in 3,triangular fibrocartilage complex (TFCC) debridement in 5 and TFCC repair in one.All the patients were anesthetized using portal site local anesthesia (PSLA) technique.Additional local infiltration around ulnar-sided wrist incisions was performed in 2 TFCC repairs.Bupivacaine was used for both techniques.The effects were evaluated using a ten-point visual analogue scale (VAS).Results Desired objectives were achieved in all patients.No operative complication was observed.Mild pain was noted in all the patients when local anesthetic was injected to the portal sites,with an average VAS score of 2.5 points (from 1 to 3 points).In the following arthroscopic procedures,most of the patients did not report any discomfort.Only one patient undergoing TFCC repair reported mild pain (VAS score of 3 points) during ulnar-carpal suture procedure.Conclusion The new WALANT technique is safe,time-saving,economical and capable of pain control during arthroscopy for numerous wrist injuries and conditions.