Wide awake surg
Alle deler > BILL > Studier > Hånd abs
Lied L, Borchgrevink GE, Finsen V.
WIDE AWAKE HAND SURGERY
J Hand Surg (AP) 2017; 22: 292-6.
DOI: 10.1142/S0218810417500320
Background: “Wide awake hand
surgery”, where surgery is performed in local anaesthesia with adrenaline,
without sedation or a tourniquet, has become widespread in some countries. It
has a number of potential advantages and we wished to evaluate it among our
patients. Methods: All 122 patients
treated by this method during one year were evaluated by the surgeons and the
patients on a numerical scale from 0 (best/least) to 10 (worst/most). Theatre time was compared to that recorded for
a year when regional or general anaesthesia had been used.
Results: The patients’ mean score
for the general care they had received was 0.1 (SD 0.6), for pain during lidocaine
injection 2.4 (SD 2.2), for pain during surgery 0.9 (SD 1.5), and for other
discomfort during surgery 0.5 (SD 1.4). Eight
reported that they would want general anaesthesia if they were to be operated
again. The surgeons’ mean evaluation of bleeding during surgery was 1.6 (SD
1.8), oedema during surgery 0.4 (SD 1.1), general disadvantages with the method
1.0 (SD 1.6) and general advantages 6.5 (SD 4.3). The estimation of advantages
was 9.9 (DS 0.5) for tendon suture. 28 patients needed intra-operative
additional anaesthesia. The proportion was lower among trained hand surgeons
and fell significantly during the study period. Non-surgical theatre time was
46 (SD 15) minutes during the study period and 55 (SD 22) minutes during the
regional/general period (p<0.001). This gain was cancelled out by a longer
surgery time during the wide awake period.
Conclusions: Wide awake surgery is
fully acceptable to most patients. It has a number of advantages over general
or regional anaesthesia, but we feel it is unlikely to improve the efficiency
of the operating theatre.