Keywords
Ambulatory surgical procedures
Hand surgery
WALANT
Ambulatory care
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Abstract
Objectives: To compare procedure time, costs, and complications for STC correction between the WALANT technique performed in an outpatient setting and a conventional surgical center. Methods: This is a randomized clinical trial with 47 patients who had an absolute indication for surgery and underwent surgical opening of the transverse carpal ligament. Patients were randomized into a group that would undergo outpatient surgery and another in the conventional surgical center. Procedure time, total cost, and perioperative complications were evaluated. The variables and outcome measures were plotted and data normality was evaluated via the Student's t-test, the Chi-square and Mann-Whitney tests were used when indicated, using SPSS software (version 21). Results: Among the 47 patients, 25 underwent the procedure in an outpatient setting and 22 in the conventional surgical center. A shorter preparation time, surgery time, and hospital stay were observed in the outpatient group. This group also had lower costs and fewer complications. Conclusion: The WALANT technique used in an outpatient setting for carpal tunnel decompression surgery is safe, effective, and provides a shorter hospital stay, significant reduction in medical-hospital costs, and fewer complications.
References
AYHAN E e AKASLAN F. Patients’ perspective on carpal tunnel release with walant or intravenous regional anesthesia. Plast Reconstr Surg. 2020; 145(5): 1197-1203.
BAEK H, et al. Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. Abe T, ed. PLoS ONE. 2018; 13(4): 0195901.
BLAND JDP, et al. Carpal tunnel syndrome. BMJ. 2007; 335(7615): 343–346.
CHAMMAS M, et al. Carpal tunnel syndrome - Part I (Anatomy, physiology, etiology and diagnosis). Rev bras ortop. 2014; 49: 429-436.
D’AURIA JL, et al. Accuracy of surgeon diagnosis in predicting carpal tunnel syndrome. Hand (N Y). 2021; 16(2): 179-182.
FENG B, et al. Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health. 2021; 21(1): 57.
FRANK SG e LALONDE DH. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Canadian Journal of Plastic Surgery. 2012;2 0(2): 71-73.
JENKINS PJ, et al. The outcome of carpal tunnel decompression in patients with diabetes mellitus. J Bone Joint Surg Br. 2012; 94(6): 811-814.
KI LEE S, et al. A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet. Orthopaedics & Traumatology: Surgery & Research. 2020; 106(8): 1645-1651.
LALONDE DH e WONG A. Dosage of local anesthesia in wide awake hand surgery. J Hand Surg Am. 2013; 38(10): 2025-2028.
LECH L, et al. Open carpal tunnel release under walant – suitable for all ages? Journal of Hand Surgery Global Online. 2021; 3(3): 129-132.
LUCKHAUPT SE, et al. Prevalence and work-relatedness of carpal tunnel syndrome in the working population. Am J Ind Med. 2013; 56(6): 615-624.
NETO PJP, et al. É seguro o uso de anestésico local com adrenalina na cirurgia da mão? Técnica walant. Rev. Brasileira de Ortopedia. 2017; 52(4): 383-389.
OSIAK K, et al. Carpal tunnel syndrome: state-of-the-art review. Folia morphologica, 2022; 81(4): 851–862.
PADUA L, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016; 15(12): 1273-1284.
RELLÁN I, et al. What is the infection rate of carpal tunnel syndrome and trigger finger release performed under wide-awake anesthesia? Hand (New York, NY). 2021; 18(2): 198-202.
SRAJ S. Carpal tunnel release with wide awake local anesthesia and no tourniquet: with versus without epinephrine. Hand (NY). 2021; 16(5): 592-594.
TAI TW, et al. Ultrasonography for diagnosing carpal tunnel syndrome: a meta-analysis of diagnostic test accuracy. Ultrasound Med Biol. 2012; 38(7): 1121–1128.
THOMSON CJ, et al. A critical look at the evidence for and against elective epinephrine use in the finger: Plastic and Reconstructive Surgery. 2007; 119(1): 260-266.
WESTENBERG RF, et al. Revision carpal tunnel release: risk factors and rate of secondary surgery. Plast Reconstr Surg. 2020; 145(5): 1204-1214.