Estudo prospectivo, comparativo do efeito analgésico entre técnica WALANT e anestesia local associada à sedação para cirurgia de mão
Data
2022-11-21
Autores
Ramos, Patrick Rech [UNIFESP]
Orientadores
Sakata, Rioko Kimiko [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Justificativa: Em cirurgias da mão, houve aumento de interesse pela técnica WALANT (wide awake, local anesthesia, no tourniquet). Para procedimentos de pequeno porte ela é uma técnica já implementada em várias partes do mundo. Na técnica é realizada em sala cirúrgica ambulatorial, agilizando a realização de cirurgias e reduzindo o custo. A aceitação desse tipo de anestesia por parte do paciente é boa, a partir do momento que ele entende seus benefícios. Não há relato de aumento de complicações em relação as cirurgias realizadas no centro cirúrgico. Não foram encontrados muitos estudos nacionais e os disponíveis se limitam a relatar sobre o uso de anestesia local com adrenalina e sua segurança. Dessa forma este estudo se faz necessário para avaliar a intensidade da dor, conforto do paciente, necessidade de complementação e efeitos adversos. Objetivos: O objetivo primário deste estudo foi comparar a técnica WALANT com a anestesia local associada à sedação em relação a intensidade da dor para procedimentos cirúrgicos de pequeno porte da mão. Os objetivos secundários foram avaliar a necessidade de complementação analgésica intra e pós-operatória e os efeitos adversos. Método: O estudo foi clínico, prospectivo, randomizado e comparativo. O tamanho da amostra em cada grupo foi determinado após avaliação estatística dos resultados de um projeto piloto. Os participantes foram alocados em um dos dois grupos. Os pacientes do grupo 1 foram submetidos a técnica WALANT e os do grupo 2 foram submetidos a anestesia local associada a sedação, para cirurgia eletiva. Os procedimentos cirúrgicos foram: síndrome do túnel do carpo, tenossinovite de De Quervain, cisto sinovial, cisto de dedo e dedo em gatilho. Resultados: Não houve diferença entre os grupos na intensidade máxima da dor entre grupo WALANT (1sem: 3,0±2,0; 2sem: 1,2±1,9; 4sem: 0,5±1,6) e local associada à sedação (1sem: 3,2±2,7; 2sem: 1,4±2,3; 4sem: 0,6±1,4). Não houve diferença na necessidade de complementação intraoperatória com anestésico local. Não houve diferença entre os grupos em relação ao conforto durante a cirurgia (WALANT= 9,5+1,3; local + sedação= 9,71+1,0; teste de Mann-Whitney; p=0,314. Não houve diferença entre os grupos nos efeitos adversos e complicações entre os grupos. Não houve diferença entre os grupos na necessidade de complementação de analgésicos pós-operatória. Nenhum evento adverso grave foi observado. Conclusões: Na técnica WALANT a intensidade da dor, a necessidade de complementação, o conforto para o paciente e os efeitos adversos foram semelhantes à da anestesia local associada a sedação, para cirurgias de pequeno porte em mão.
Background and Objectives: There has been increased interest in the WALANT (wide awake, local anesthesia, no tourniquet) technique for small hand surgeries. This is a technique already implemented for those types of surgeries in many parts of the world. The technique is performed as an in office procedure, which reduces cost and free up the operating room for other surgeries. Patient compliance is good once they understand the benefits of WALANT. There are no reports of increased complication with this technique. Not many local studies are available and the ones that are only report on the safety of the procedure. Thus this study is needed to evaluate intensity of pain, patient comfort, necessity of complementation and adverse effects. Methods: A prospective, randomized, comparative, clinical study was carried out. The sample size in each group was determined after statistical evaluation of the results of a pilot project. The participants were allocated to one of two groups; those in group 1 were submitted to the WALANT technique, and those in group 2, to local anesthesia associated with sedation, for elective surgery. The surgical procedures were carpal tunnel syndrome release, De Quervain's tenosynovitis, synovial cyst, finger cyst, and trigger finger. Pain intensity, need for complementation and evolution to complex regional pain syndrome were evaluated. Results: There was no difference between groups in pain intensity after WALANT (1wk: 3.0±2.0; 2wk: 1.2±1.9; 1m: 0.5±1.6 or local + sedation (1wk: 3.2±2.7; 2wk: 1.4±2.3; 1m: 0.6±1.4) and need for intraoperative complementation. There was no significant difference in the amount of opioid applied postoperatively between the groups. There was no difference between groups regarding comfort during surgery (WALANT= 9.5+1.3; local + sedation= 9.71+1.0; Mann-Whitney test; p=0.314). There was no difference in adverse effects and complications between the groups. Hematoma was the most frequent adverse event (26 occurrences, of these in G1: 39.3%; G2: 35.7%). No severe adverse events were observed. Conclusions: The WALANT technique promoted an analgesic effect similar to that of local anesthesia associated with sedation, without increasing adverse effects. The necessity of intraoperative complementation and comfort during surgery were also similar in both groups.
Background and Objectives: There has been increased interest in the WALANT (wide awake, local anesthesia, no tourniquet) technique for small hand surgeries. This is a technique already implemented for those types of surgeries in many parts of the world. The technique is performed as an in office procedure, which reduces cost and free up the operating room for other surgeries. Patient compliance is good once they understand the benefits of WALANT. There are no reports of increased complication with this technique. Not many local studies are available and the ones that are only report on the safety of the procedure. Thus this study is needed to evaluate intensity of pain, patient comfort, necessity of complementation and adverse effects. Methods: A prospective, randomized, comparative, clinical study was carried out. The sample size in each group was determined after statistical evaluation of the results of a pilot project. The participants were allocated to one of two groups; those in group 1 were submitted to the WALANT technique, and those in group 2, to local anesthesia associated with sedation, for elective surgery. The surgical procedures were carpal tunnel syndrome release, De Quervain's tenosynovitis, synovial cyst, finger cyst, and trigger finger. Pain intensity, need for complementation and evolution to complex regional pain syndrome were evaluated. Results: There was no difference between groups in pain intensity after WALANT (1wk: 3.0±2.0; 2wk: 1.2±1.9; 1m: 0.5±1.6 or local + sedation (1wk: 3.2±2.7; 2wk: 1.4±2.3; 1m: 0.6±1.4) and need for intraoperative complementation. There was no significant difference in the amount of opioid applied postoperatively between the groups. There was no difference between groups regarding comfort during surgery (WALANT= 9.5+1.3; local + sedation= 9.71+1.0; Mann-Whitney test; p=0.314). There was no difference in adverse effects and complications between the groups. Hematoma was the most frequent adverse event (26 occurrences, of these in G1: 39.3%; G2: 35.7%). No severe adverse events were observed. Conclusions: The WALANT technique promoted an analgesic effect similar to that of local anesthesia associated with sedation, without increasing adverse effects. The necessity of intraoperative complementation and comfort during surgery were also similar in both groups.