Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study.

Autor: Chen CT; Department of Clinical Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan., Chou SH; Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.; Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan., Huang HT; Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.; Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan., Fu YC; Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.; Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.; Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.; Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan., Jupiter JB; Hand and Arm Research Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA., Liu WC; Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. WLIU29@mgh.harvard.edu.; Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan. WLIU29@mgh.harvard.edu.; Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. WLIU29@mgh.harvard.edu.; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. WLIU29@mgh.harvard.edu.; Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan. WLIU29@mgh.harvard.edu.; Hand and Arm Research Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA. WLIU29@mgh.harvard.edu.; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. WLIU29@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Journal of orthopaedic surgery and research [J Orthop Surg Res] 2023 Oct 03; Vol. 18 (1), pp. 746. Date of Electronic Publication: 2023 Oct 03.
DOI: 10.1186/s13018-023-04243-0
Abstrakt: Background: Distal radius fractures (DRF) are frequently treated with internal fixation under general anesthesia or a brachial plexus block. Recently, the wide-awake local anesthesia with no tourniquet (WALANT) technique has been suggested as a method that results in higher patient satisfaction. This study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and balanced anesthesia (BA).
Methods: Ninety-three patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received BA, comprised of multimodal pain control brachial plexus anesthesia with light general support. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0-10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals and mean ± standard deviation.
Results: The mean age of patients in the WALANT group was higher than in the BA group (63 ± 17 vs. 54 ± 17, P = 0.005), and there were fewer intra-articular DRF fractures in the WALANT group than in the BA group (AO type A/B/C: 30/3/5 vs. 26/10/19, P = 0.009). The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; - 8.0% [ - 15.7 to - 0.2%]) and 6-month pronation (92% vs. 100%; - 9.1% [ - 17.0 to - 1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0-22.1%]). The overall satisfaction was comparable in the WALANT and BA groups (8.7 vs. 8.5; 0.2 [ - 0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7 ± 2.0, an intraoperative pain scale of 1.2 ± 1.9, and an intraoperative anxiety scale of 2.3 ± 2.8.
Conclusion: The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and BA groups. With meticulous preoperative planning, the WALANT technique could be an alternative for DRF plating surgery in selected patients. Trial registration This retrospective study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20210201).
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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