The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial
Abstract Background The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on th...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-024-02504-x |
| _version_ | 1827300952275681280 |
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| author | Mahmoud Mohammed Alseoudy Elsayed Mohamed Abdelkarime Khaled Nour May Elsherbiny Badr |
| author_facet | Mahmoud Mohammed Alseoudy Elsayed Mohamed Abdelkarime Khaled Nour May Elsherbiny Badr |
| author_sort | Mahmoud Mohammed Alseoudy |
| collection | DOAJ |
| description | Abstract Background The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on the analgesic properties of the WALANT technique, which is the aim of our study. Methods A total of 128 patients aged more than 18 years were scheduled for surgical flexor tendon injury repair using WALANT technique. Patients were divided into two equal groups. Ultrasound-guided subcutaneous injection of lidocaine 1% with dexmedetomidine (1 µg/kg), Group D, or without dexmedetomidine, Group C, was performed at four points: proximal to the wrist joint, the distal forearm, palm region, and proximal phalanges. The primary outcome was total morphine consumption throughout the first postoperative day. Secondary outcomes included number of patients requiring rescue analgesia, time to first analgesic request, and pain score. Results Total morphine consumption was significantly (P < 0.001) lower in group D (2.66 ± 0.998) than in group C (3.66 ± 1.144) mg. Number of patients requiring rescue analgesia was significantly (P < 0.001) lower in group D (54.7% (35)) than group C (100.0% (64)). The time for first request for analgesia was significantly (P < 0.001) longer in group D (11.31 ± 6.944) than in group C (5.91 ± 4.839) h. Pain score was significantly higher in group C than D at three (P < 0.001), and six (P = 0.001) hours (P = 0.001) postoperatively. Conclusion Dexmedetomidine significantly improves the analgesic quality of WALANT when added to lidocaine with less opioid consumption. Trial registration (ID: PACTR202203906027106; Date: 31/07/2023). |
| first_indexed | 2024-04-24T16:14:49Z |
| format | Article |
| id | doaj.art-ce9562b8d8a24615a155c1c0d95adb38 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-24T16:14:49Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-ce9562b8d8a24615a155c1c0d95adb382024-03-31T11:33:23ZengBMCBMC Anesthesiology1471-22532024-03-012411710.1186/s12871-024-02504-xThe value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trialMahmoud Mohammed Alseoudy0Elsayed Mohamed Abdelkarime1Khaled Nour2May Elsherbiny Badr3Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura UniversityDepartment of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura UniversityDepartment of Orthopedic Surgery, Faculty of Medicine, Mansoura UniversityDepartment of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura UniversityAbstract Background The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on the analgesic properties of the WALANT technique, which is the aim of our study. Methods A total of 128 patients aged more than 18 years were scheduled for surgical flexor tendon injury repair using WALANT technique. Patients were divided into two equal groups. Ultrasound-guided subcutaneous injection of lidocaine 1% with dexmedetomidine (1 µg/kg), Group D, or without dexmedetomidine, Group C, was performed at four points: proximal to the wrist joint, the distal forearm, palm region, and proximal phalanges. The primary outcome was total morphine consumption throughout the first postoperative day. Secondary outcomes included number of patients requiring rescue analgesia, time to first analgesic request, and pain score. Results Total morphine consumption was significantly (P < 0.001) lower in group D (2.66 ± 0.998) than in group C (3.66 ± 1.144) mg. Number of patients requiring rescue analgesia was significantly (P < 0.001) lower in group D (54.7% (35)) than group C (100.0% (64)). The time for first request for analgesia was significantly (P < 0.001) longer in group D (11.31 ± 6.944) than in group C (5.91 ± 4.839) h. Pain score was significantly higher in group C than D at three (P < 0.001), and six (P = 0.001) hours (P = 0.001) postoperatively. Conclusion Dexmedetomidine significantly improves the analgesic quality of WALANT when added to lidocaine with less opioid consumption. Trial registration (ID: PACTR202203906027106; Date: 31/07/2023).https://doi.org/10.1186/s12871-024-02504-xWALANTDexmedetomidineMorphineFlexor tendon repairAnalgesiaUltrasound |
| spellingShingle | Mahmoud Mohammed Alseoudy Elsayed Mohamed Abdelkarime Khaled Nour May Elsherbiny Badr The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial BMC Anesthesiology WALANT Dexmedetomidine Morphine Flexor tendon repair Analgesia Ultrasound |
| title | The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial |
| title_full | The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial |
| title_fullStr | The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial |
| title_full_unstemmed | The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial |
| title_short | The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial |
| title_sort | value of local dexmedetomidine as an adjuvant to ultrasound guided wide awake local anesthesia no tourniquet walant in flexor tendon repair surgeries a randomized controlled trial |
| topic | WALANT Dexmedetomidine Morphine Flexor tendon repair Analgesia Ultrasound |
| url | https://doi.org/10.1186/s12871-024-02504-x |
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