Development of the Manchester wide-awake hand trauma service in 2020: the patient experience

Choukairi, Fouzia; Ibrahim, Ibrahim; Murphy, Ralph; Reid, Adam J.; Winterton, Robert I.S.; Bedford, James D; Wong, Jason

doi:10.1177/17531934211006279

Cited by 9 publications

(12 citation statements)

References 9 publications

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“…Procedure rooms are less expensive and more efficient. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 The savings begin before the patient steps foot in the procedure room, with no need for preoperative laboratory testing and medical evaluations. In a study of preoperative carpal tunnel patients, Greenfield et al 8 found a per-patient average cost of $858.74 was spent on preoperative work-ups and nonsurgical management of patients who underwent carpal tunnel release.…”

Section: Discussionmentioning

confidence: 99%

“… 8 Additionally, there are cost savings associated with the decreased need for surgical drapes, equipment, and hospital staffing. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 There is also a decrease in the waste generated by these procedures, as they are typically done under minor field sterility, which consists of sterile prep, a single drape, a minor instrument tray, sterile gloves and a mask (no gown or antibiotics), and local anesthesia. 16 , 29 …”

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confidence: 99%

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Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

McKnight¹,

Smith²,

MacFadden³

et al. 2022

Journal of Hand Surgery Global Online

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

McKnight¹,

Smith²,

MacFadden³

et al. 2022

Journal of Hand Surgery Global Online

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“…A pesar de esta circunstancia, la creación de este tipo de unidades con circuitos independientes ha demostrado que es útil en tiempos de pandemia, en los que, por distintas circunstancias, los quirófanos ordinarios tienen que interrumpirse en el tiempo. 33 La vía clínica establecida en este artículo cumple todos los requisitos, desde el punto de vista de la Cirugía Ambulatoria, 5 de la legislación española relativa a la CMA, 8,17 y de la seguridad y consentimiento del paciente, 19 por lo que su implantación en distintos centros es factible, y queda de nuestra parte hacerla real y viable, atendiendo solo a las variaciones que puedan mostrar los distintos tipos de centro y localizaciones geográficas.…”

Section: Discussionunclassified

Via clínica para cirugía mediante técnica WALANT fuera del estándar de cirugía mayor ambulatoria

Sanjuán-Cerveró¹,

Peña-Molina²,

Sanjuan-Aragó³

et al. 2022

Revista Iberoamericana de Cirugía de la Mano

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Resumen Objetivo Desarrollar y valorar al año una vía clínica para procedimientos de cirugía de mano utilizando anestesia local sin torniquete y con el paciente despierto, denominada técnica WALANT (wide awake, local anesthesia, no tourniquet, en inglés). Materiales y Métodos Se planificó y ejecutó una vía clínica para pacientes de cirugía de mano no compleja, y se realizó una comparativa de costes entre dotación completa del quirófano y cirugía local con la técnica WALANT.Como indicadores de la calidad, se calculó la tasa de suspensiones quirúrgicas y el número de pacientes intervenidos. Se comparó el tiempo medio de estancia hospitalaria entre los pacientes intervenidos de forma ordinaria y en el quirófano WALANT. Se valoró la reducción en la lista de espera quirúrgica en síndrome del túnel del carpo y dedo en gatillo. Resultados Los gastos directos fueron un 48,9% menores en el procedimiento WALANT. Se valoraron 254 pacientes en 2020 y 339 en 2021. La tasa de suspensión fue del 5,1% (0,4% por motivos médicos). El tiempo de estancia en el hospital fue significativamente menor para los pacientes del grupo WALANT (z = -8,743; p = 0,000). La disminución en la lista quirúrgica fue de 113 días. Conclusiones La cirugía mediante la técnica WALANT adecuada a esta vía clínica permite la intervención de pacientes con menos recursos, lo que disminuye los gastos directos y alivia las unidades de Cirugía Ambulatoria.

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“…The boundaries of the wide-awake local anesthesia no tourniquet (WALANT) method have been pushed to new frontiers in the face of limited operating room capacity. There are reports of using local anesthesia for open reduction and internal fixation to treat distal radial fracture 93 , for trapeziometacarpal joint arthroplasty 94 , and for hand fracture fixation 68 , further establishing WALANT as a safe, inexpensive means for surgical care associated with a satisfying patient experience [95][96][97][98] .…”

Section: Covid-19mentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

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Development of the Manchester wide-awake hand trauma service in 2020: the patient experience

Cited by 9 publications

References 9 publications

Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

Wide-Awake Hand Surgery Has Its Benefits: A Study of 1,011 Patients

Via clínica para cirugía mediante técnica WALANT fuera del estándar de cirugía mayor ambulatoria

What’s New in Hand and Wrist Surgery

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