Distal radius fracture fixation using WALANT versus general and regional anesthesia: A systematic review and meta-analysis.

Autor: Rigney B; Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland; Discipline of Surgery, National University of Ireland Galway, Galway, Ireland. Electronic address: brianrigney@rcsi.com., Casey C; Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland., McDonald C; Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland., Pomeroy E; Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland., Cleary MS; Trauma and Orthopaedic Department, University Hospital Waterford, Dunmore Road, Waterford, Ireland; Department of Surgery, College of Medicine & Health, University College Cork, Cork, Ireland.
Jazyk: angličtina
Zdroj: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland [Surgeon] 2023 Feb; Vol. 21 (1), pp. e13-e22. Date of Electronic Publication: 2022 Feb 23.
DOI: 10.1016/j.surge.2022.01.006
Abstrakt: Background: WALANT (wide-awake local anaesthetic no tourniquet) has become a popular technique in upper limb surgery including distal radius fracture fixation. The purpose of this systematic review and meta-analysis is to assess the effectiveness of the WALANT technique in distal radius fracture fixation, and to compare it to both general and regional anaesthesia.
Methods: Pubmed, Embase, and Scopus databases were searched on 26/06/21 according to the PRISMA guidelines with the following search terms: radius, WALANT, "local anesthetic", wide-awake surgery. All studies comparing WALANT with other forms of anaesthesia for distal radius fracture fixation were included.
Results: 110 articles were identified, six studies (410 patients) were included, 164 of these patients were in the WALANT group. Two patients (1.2%) in the WALANT group and seven (6.5%) in the regional anaesthesia group required conversion to general anaesthesia. There was no statistically significant difference in post-operative complications, intra-operative VAS pain scores, operative times, functional or radiological outcomes. A statistically significant 8.6 mls increase in pooled mean blood loss in the WALANT group was noted (p = 0.02) although the clinical significance of this is doubtful.
Conclusion: The WALANT technique for distal radius fracture fixation is non-inferior to regional and general anaesthesia. It is a safe and effective technique that surgeons may consider utilising, especially for patients not suitable for general anaesthetic or in centres in which there is a lack of access to specialist anaesthetic equipment and care.
Competing Interests: Declaration of competing interest None to declare.
(Copyright © 2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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