Wide-awake local anesthesia for clavicle fracture fixation: A case report

Niempoog, Sunyarn; Tanariyakul, Yot; Jaroenporn, Woraphon

doi:10.1016/j.ijscr.2021.01.005

Cited by 7 publications

(16 citation statements)

References 11 publications

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“…Following a thorough review of the titles, abstracts, full-text, and reference lists, we included and extracted data from a total of 44 studies and/or reports containing patient data, spanning a total of 3161 patients with clavicular fractures who received some form of regional anesthesia and analgesia. We excluded one retracted article and its retraction note from the final list of 44 studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. There were 5 RCTs, 5 prospective observational studies, 5 retrospective observational studies, and 29 case reports/case series included in this scoping review ( Figure 1 and Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Lastly, awake clavicle fracture fixation surgery under tumescent local anesthesia (LA) alone has also been described in a case report, as well as in a case series [ 22 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…This technique utilizes a tumescent injection of lignocaine and adrenaline to provide both LA and vasoconstriction. Subcutaneous infiltration produces nociceptive blockade, and subperiosteal infiltration has been thought to facilitate LA spread via nutrient or transcortical vessels from the periosteum into the endosteal circulation, thus, blocking sensory fibers in the periosteum, mineralized bone, and bone marrow [ 22 , 27 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Two reports [ 22 , 27 ] demonstrated the potential of local infiltration as a viable anesthetic technique ( Supplementary Table S2 ). Niempoog et al used 50 mL 1% lignocaine with adrenaline and sodium bicarbonate for clavicle fracture fixation with no intraoperative pain and no reported complications [ 22 ]. A series of 16 cases was also reported by Ahmad et al [ 27 ] who successfully used 40 mL 1% lignocaine with adrenaline in patients without sedation or conversion to GA. Only two patients had mild pain (2/10) during reduction.…”

Section: Discussionmentioning

confidence: 99%

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Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

et al. 2022

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Objective. Clavicle fractures are common injuries potentially associated with significant perioperative pain. However, this region’s complex sensory innervation poses a challenge for regional anesthetic or analgesic (RA) techniques. We conducted this scoping review to summarize the current literature, particularly with regards to motor-sparing techniques. Methods. A scoping review was carried out in accordance with the Joanna Briggs Institute’s framework. All articles describing the use of RA for clavicle fractures or surgery were included. PubMed®, Ovid MEDLINE®, EMBASE®, Scopus®, CINAHL®, and the Cochrane database were searched without language restrictions. Results. Database searches identified 845 articles, 44 of which were included in this review, with a combined patient total of 3161. We included all peer-reviewed publications containing clinical data and summarized the findings. Conclusions. Current evidence of RA techniques in clavicle surgery is heterogeneous, with different approaches used to overcome the overlapping sensory innervation. The literature largely comprises case reports/series, with several randomized controlled trials. Intermediate cervical plexus block is the regional technique of choice for clavicle surgery, and can provide reliable surgical anesthesia when combined with an interscalene block. Cervical plexus block can provide motor-sparing analgesia following clavicle surgery. Promising alternatives include the clavipectoral block, which is a novel motor-sparing regional technique. Further studies are required to determine the efficacy and safety of various techniques.

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Section: Resultsmentioning

confidence: 99%

“…Lastly, awake clavicle fracture fixation surgery under tumescent local anesthesia (LA) alone has also been described in a case report, as well as in a case series [ 22 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

et al. 2022

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Effects of fixation of clavicle fracture using wide-awake local anesthesia no tourniquet (WALANT) technique on intra-operative bleeding volume, surgical duration, and post-operatively visual analog scale (VAS); A case series study

Kafiabadi¹,

Sabaghzadeh²,

Biglari³

et al. 2023

Injury

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Infiltration Technique for the Fourth FDS Opponensplasty Under WALANT

Jaroenporn,

Harnboonseth,

Vechasilp

et al. 2023

Techniques in Orthopaedics

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Background: Wide-awake Local Anesthesia No Tourniquet (WALANT) is a surgical technique that relies on anesthetic and hemostatic agents to provide conditions suitable for hand surgery without sedation and a tourniquet. The opponensplasty using the fourth flexor digitorum superficialis tendon transfer with the pisiform pulley is one of the most used in severe carpal tunnel syndrome patient who is unable to perform thumb opposition due to thenar muscle atrophy with the benefit of small incision, less soft tissue dissection, easy to perform, good esthetic result and has minor morbidity. Key advantages of the pisiform pulley provide balancing abduction and flexion strength of the thumb. To date, there is no report using the WALANT technique for the fourth flexor digitorum superficialis opponensplasty with pisiform pulley. Materials and Method: Between January 2019 and January 2022, 18 patients (4 males and 14 females) with severe carpal tunnel syndrome with thenar muscle atrophy underwent fourth flexor digitorum superficialis opponensplasty as day surgery under the WALANT technique. Operative data, visual analog scale (VAS) pain scores, and complications were recorded. All patients underwent the procedure without any complications. Results: The average age of the patients was 58.4 (43 to 62) year-old. The average operative time was 38.4 (17 to 47) minutes. The average VAS score during the anesthetic injection was 6.43 (4 to -8). The average VAS pain score during the operation was 2.1 (1 to 3). The mean intraoperative blood loss was 3 (2.6 to 6.2) mL. Conclusions: The WALANT technique is safe and can be used as alternative anesthesia for the fourth flexor digitorum superficialis opponensplasty with pisiform pulley. This technique overcomes the problem of judging the appropriate amount of transfer tension by observing awake patients actively. Levels of Evidence: Therapeutic study, level IV

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Wide-awake local anesthesia for clavicle fracture fixation: A case report

Cited by 7 publications

References 11 publications

Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1—A Scoping Review

Effects of fixation of clavicle fracture using wide-awake local anesthesia no tourniquet (WALANT) technique on intra-operative bleeding volume, surgical duration, and post-operatively visual analog scale (VAS); A case series study

Infiltration Technique for the Fourth FDS Opponensplasty Under WALANT

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