gms | German Medical Science

Background: Wide-awake hand surgery (WAHS) allows the performance of various surgical procedures under local anesthesia by injecting lidocaine supplemented with epinephrine. WAHS eliminates the need for sedation, regional or general anesthesia and tourniquet use. Although the repair of finger flexor or extensor tendons, and carpal tunnel release are regularly performed under WAHS with favorable results, the clinical outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) under local anesthesia remain unclear. The purpose of this study was to evaluate postoperative outcome after LRTI performed via WAHS.

Methods: We retrospectively compared patients who underwent trapeziectomy and LRTI either via WAHS (six patients) or under brachial plexus block (BPB; six patients). The following variables were assessed: patient demographics, pain scores on a visual analog scale on postoperative days one and seven, complications requiring a reoperation, postoperative satisfaction and willingness to undergo repeat surgery. The cost of the procedure was evaluated using the Swiss pricing system for ambulatory surgery. Due to the small number of patients, only descriptive statistics are provided.

Results: Pain scores on postoperative day one were slightly, lower in the WAHS group than in the BPB group. The cost of the procedure was 23% lower in the WAHS group. Long-term satisfaction and willingness to repeat the operation however did not differ between the two groups.

Conclusion: In this limited group of patients, the clinical outcomes of patients undergoing trapeziectomy under WAHS were similar to those of patients who underwent the surgery under BPB; however, the cost of the former surgery was 23% lower.