gms | German Medical Science

Objectives: The purpose of this paper is to expose our personal experience regarding Hand Surgery performed with local anesthesia without tourniquet and without sedation. We confirm data from literature, but, also, we bring some considerations out of our personal experience. We show that the use of this method with smaller quantities of anesthetic is possible with good results and maximum comfort for the patient and for the surgeon.

Method: Our study is based on 35 cases, 15 women and 20 men, aged between 20 and 76 years with different hand and finger pathology. Chronic diseases included Dupuytren disease in 13 cases (various stages of evolution), Carpal Tunnel Syndrome in 14 cases and trigger finger in 4 cases. The other 4 cases are represented by acute pathology: finger trauma with flexor tendons and digital collateral nerves section. All the surgical procedures were performed with local anesthesia, using lidocaine and epinephrine (concentration 1:100000). In 55% of cases, we used the recommended doses from the literature, but for the rest we used smaller quantities of anesthetic. For 8 cases of Dupuytren Disease, second degree, we started with 8 ml (not 10 ml) in the palm, followed by injecting 1 ml at the proximal phalanges. In the other 3 cases, total amount of anesthesia was only 7 ml. For Carpal Tunnel Syndrome, in 7 cases we used 10 ml of anesthetic, in 5 cases - 8 ml and in 2 cases, only 5 ml were sufficient. Injection points were, always, the ones cited and recommended in the literature.

Results: The results were very good. There were no recorded incidents or accidents intra or postsurgical procedure, related to the type of used anesthesia. The hospitalization was, in general, a few hours. Only in 3 cases, the hospitalization was 24 hours and that was related to the age of the patients and to their associated diseases. Patient's satisfaction was maximum in all cases.

Conclusion: The Walant technique is easy, safe, assuring comfort to the patient but, also, to the surgeon, with minimal bleeding and with the possibility of performing a correct and complete dissection. Cooperation with the patient during surgery is very beneficial by verifying the accuracy of surgical success. The small costs, decreased hospitalization, patient and surgeon comfort make this technique possible to be used at a larger scale and, sometimes, being possible to utilize o smaller dose of anesthetic than described in the literature.