An Open-Label Comparison of Local Anesthesia with or without Sedation for Minor Hand Surgery

Rozanski, Marta; Neuhaus, Valentin; Reddy, Rajesh; Jupiter, Jesse B.; Rathmell, James P.; Ring, David

doi:10.1007/s11552-014-9670-6

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…Although it is clear that surgeons have several options to consider when performing trigger finger release (TFR) surgery for appropriately indicated patients, including choice of surgical setting and anesthetic type, the associated cost implications are less clear but may be substantial. With regard to anesthetic type, performing TFR under local anesthetic without sedation has been shown to be effective, 7–10 while other anesthetic methods including Bier block, monitored anesthesia care (MAC), regional block, or general anesthesia are also well-established options.…”

Section: Introductionmentioning

confidence: 99%

Cost Implications of Varying the Surgical Setting and Anesthesia Type for Trigger Finger Release Surgery

Kazmers

Stephens

Presson

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Section: Introductionmentioning

confidence: 99%

Cost Implications of Varying the Surgical Setting and Anesthesia Type for Trigger Finger Release Surgery

Kazmers

Stephens

Presson

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…Only 4.9 % of patients had surgery under local anesthesia alone. Local anesthesia was associated with more events in the surgery center and more post-discharge problems, perhaps related to pain [21]. The fact that involvement of an anesthesiologist and/or CRNA was associated with more perioperative and postoperative events might be related to problems associated with IV sedation, but may also reflect co-existing medical conditions in this population that led to the need for oversight by a skilled anesthesia provider.…”

Section: Discussionmentioning

confidence: 96%

“…We found that local anesthesia, IV sedation and regional anesthesia were rather associated with perioperative symptoms in the ambulatory surgery center than general anesthesia. This can be explained with more pain [21]. In addition, this is however speculative, patients after general anesthesia are better informed about the early postoperative course.…”

Section: Discussionmentioning

confidence: 99%

Symptoms During or Shortly After Isolated Carpal Tunnel Release and Problems Within 24 hours After Surgery

et al. 2016

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This study used the National Survey of Ambulatory Surgery (NSAS) database to measure the incidence of and risk factors for symptoms in the ambulatory surgery center and problems within 24 h after isolated carpal tunnel release (CTR). The NSAS contained records on 400,000 adult patients with carpal tunnel syndrome who were treated with CTR in 2006, based on ICD-9 codes. The type of anesthesia used and factors associated with symptoms and problems were sought in bivariate and multivariable statistical analyses. The mean duration of the procedure was 16±8.8 min. Only 5 % were performed under local anesthesia without sedation, 45 % with IV sedation, 28 % regional anesthesia, and 19 % general anesthesia. Symptoms in the ambulatory surgery center or a problem within 24 h after discharge were recorded in 10 % of patients, all of them minor and transient, including difficulties with pain and its treatment. The strongest risk factors were male sex, age of 45 years and older, and participation of an anesthesiologist. Local anesthesia and regional anesthesia were associated with more perioperative symptoms and postoperative problems. Most CTR are performed with some sedation in the United States. CTR is a safe procedure: one in 10 patients will experience a minor issue in the perioperative or immediate postoperative period.

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“…Furthermore, a tourniquet was used on all patients. 12 This study has some weaknesses. First, there may be some selection bias as the patients were not randomized.…”

Section: Discussionmentioning

confidence: 96%

Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation

et al. 2017

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Carpal tunnel release (CTR) is the most common surgery of the hand, and interest is growing in performing it under local anesthesia without tourniquet. To better understand differences, we hypothesized that patients undergoing CTR under wide-awake local anesthesia with no tourniquet (WALANT) versus sedation (monitored anesthesia care [MAC]) would not result in a difference in outcome. Consecutive cases of electrodiagnostically confirmed open CTR across multiple surgeons at a single center were prospectively enrolled. Data included demographic data, visual analog scale, Levine-Katz carpal tunnel syndrome scale, QuickDASH questionnaire, customized Likert questionnaire, and complications. There were 81 patients enrolled in the WALANT group and 149 patients in the MAC group. There were no reoperations in either group or any epinephrine-related complications in the WALANT group. Disability and symptom scores did not differ significantly between WALANT and sedation groups at 2 weeks or 3 months. Average postoperative QuickDASH, Levine-Katz, and VAS pain scales were the same in both groups. Both groups of patients reported high levels of satisfaction at 91 versus 96% for the WALANT versus MAC groups, respectively ( > 0.05). Patients in each group were likely to request similar anesthesia if they were to undergo surgery again. Patients undergoing open CTR experienced similar levels of satisfaction and outcomes with either the WALANT or MAC techniques. There was no statistically significant difference between either group relative to the tested outcome measures. These data should facilitate surgeons and patients' choosing freely between WALANT and MAC techniques relative to complications and outcomes.

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An Open-Label Comparison of Local Anesthesia with or without Sedation for Minor Hand Surgery

Abstract: Background The purpose of this study was to assess satisfaction and pain intensity in patients undergoing minor hand surgery under local anesthesia (LA) with or without sedation.

Cited by 9 publications

References 33 publications

Cost Implications of Varying the Surgical Setting and Anesthesia Type for Trigger Finger Release Surgery

Cost Implications of Varying the Surgical Setting and Anesthesia Type for Trigger Finger Release Surgery

Symptoms During or Shortly After Isolated Carpal Tunnel Release and Problems Within 24 hours After Surgery

Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation

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