Awake Local Anesthesia Infiltration Compared to Regional Nerve Block for Hand Surgeries

Study Overview
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Brief Summary
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The study trying to fined out the best anaesthesia technique for hand flexor procedures which provide efficient anaesthesia while providing adequate surgical field exposure & less blood loss

Detailed Description
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The current study compared patients scheduled for hand surgical procedures using wide awake local anaesthetic infiltration to those receiving supra-clavicular brachial plexus block. the comparison including adequacy of pain control, blood loss, patient satisfaction, time & skills needed to provide aesthetic technique.

Official Title
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Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus Regional Anesthesia With Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults

Conditions
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Anaesthesia Conduction

Intervention / Treatment
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* Other: local anaesthesia infiltration
* Other: brachial plexus block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants were included if they were to be scheduled for Flexor tendon repair (Interventions involving flexor tendons of the wrist (Flexor Carpi Ulnaris (FCU), Flexor Carpi Radialis (FCR), and/or Palmaris Longus PL), fingers (flexor digitorum Profundus FDP and/or Flexor Digitorum Superficialis FDS) and thumb (Flexor Pollicis Longus FPL)), aged 18 years or over & of ASA physical status I or II. Exclusion Criteria: Participants were excluded if they were (American society of Anaesthesia) ASA physical status III or IV, refusal of anaesthetic procedure or refuse to participation in the study, documented hypersensitivity to lidocaine, compromised peripheral circulation (Patients with previous vascular injury, vasculitis, Buerger's disease, and scleroderma), evidence of infection at injection site, patients with ischemic heart disease or psychiatric illness and patients with concomitant injuries that needed further operative procedure under general anesthesia or spinal anesthesia.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: patients were allocated to one of two groups. one received WALANT (with no tourniqut) & the other (control) group received supra-clavicular block (with tourniquet). Groups were compared for anaesthesia efficiency
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Wide Awake Local Anesthesia (WALANT)<br>Study arm: (WALANT) patient received local anaesthesia (25ml of 2%lidocaine with 0.5 ml of adrenaline (1mg/mL) and 5 ml of 8.4% of sodium bicarbonate. the final 50 ml mixture contained 10 mg/ml Lidocaine and adrenaline 1:100,000 concentration) infiltration along rays at site of surgery (15 ml or more per ray (150 mg lidocaine) by 27G needle, 10 ml (or more) in the palm, then 2 ml in the proximal and middle phalanges and 1 ml in the distal phalanx (if required )) for hand flexor tendons repair. | Other: local anaesthesia infiltration<br>* Infiltration of 150 mg of lidocaine solution per ray at site of surgical incision for flexor tendon repair in the palm, the 2 proximal & distal phalanges<br>|
| Active Comparator: Supra Clavicular- Brachial Plexus Block (SC-BPB)<br>Control arm:(SC-BPB): ultrasound-guided injection of local aesthetics (15 mL of 2% lidocaine and 15 mL of 0.5% bupivacaine were injected incrementally over 3-5 min) at supra-clavicular level where brachial plexus trunks are located this will provide anesthesia for the whole upper limb distal to shoulder joint. | Other: brachial plexus block<br>* ultrasound-guided infiltration of local aesthetics around brachial plexus trunks & divisions<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intra-operative pain score | pain assessment during operation at the following moments: before the injection, during injections , during the incision , during gentle manipulation , during aggressive manipulation and during wound closure. | duration of operation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| anaesthesia induction time | the time taken to provide anesthesia | duration of operation | 
| Blood loss | calculated based upon the number and degree of soaking of swabs used in the operation and the amount in a suction container in the operation room. | duration of operation | 
| intra-operative preserved motor power intraoperative | surgeon test the motor power after repair of the affected tendon | duration of operation | 
| operative time | time from skin incision till last suture applied for wound closure | duration of operation | 
| patient satisfaction | was measured and recorded using five-point Likert scale[25] (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied) with checklist and a closed-ended question If you were to undergo this surgery again, would you choose the same type of anaesthesia? YES or NO  | 12 hours post operative | 
| postoperative pain scores | numeric pain rating scale (NRS)A respondent selected a whole number (0- 10 integers) that best reflects the intensity of his pain, 0-10 was recorded by a blinded investigator at 2, 4, 6, 8, 10, 12 hours postoperatively, time of 1st call for postoperative analgesia was recorded, patients received 25 mg pethidine IV if the NRS pain exceeds 3, the dose was repeated on patient's demand with 2 hours minimal time interval between doses, total analgesic dose required in the 1st twelve hours postoperatively | 12 hours postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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WALANT (Wide-Awake Local Anesthesia No Tourniquet ), Regional Anesthesia, Hand flexor Tendon Repair, Supra-clavicular brachial plexus block, Hand surgery