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      Uso da técnica WALANT para tratamento cirúrgico da síndrome do túnel do carpo: revisão da literatura Translated title: Use of the WALANT technique for the surgical treatment of carpal tunnel syndrome: literature review

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          Abstract

          RESUMO A síndrome do túnel do carpo é uma das patologias mais incidentes no membro superior; é a neuropatia compressiva mais comum, acarretando importante morbidade. Grande parcela dos acometidos necessitam de tratamento cirúrgico; desse modo, a técnica WALANT seria uma excelente opção para permitir maior celeridade do tratamento desses pacientes que o aguardam. Este estudo visa realizar uma revisão integrativa sobre a aplicação da técnica WALANT para tratamento cirúrgico da síndrome do túnel do carpo, ressaltando a eficácia e a segurança do procedimento. Foi realizada uma revisão integrativa na literatura, utilizando o descritor “Wide Awake Local Anestesia No Tourniquet”. Aplicando os critérios de elegibilidade, foram selecionados 16 estudos nas bases de dados PubMed e BVS. Os estudos selecionados não relatam complicações associadas à aplicação da técnica WALANT. A técnica WALANT apresenta evidente eficácia e segurança para o tratamento cirúrgico da síndrome do túnel do carpo, sem relatos de complicações.

          Translated abstract

          ABSTRACT Carpal tunnel syndrome is one of the most common pathologies in the upper limb; it is the most common compressive neuropathy, causing significant morbidity. Many of those affected need surgical treatment; thus, the WALANT technique would be an excellent option to allow faster treatment of patients waiting for it. This study aims to carry out an integrative review on applying the WALANT technique for the surgical treatment of carpal tunnel syndrome, emphasizing the efficacy and safety of the procedure. An integrative literature review was performed using the “Wide Awake Local Anesthesia No Tourniquet” descriptor. Sixteen studies were selected from the PubMed and VHL databases, applying the eligibility criteria. The selected studies do not report complications associated with applying the WALANT technique. The WALANT technique has evident efficacy and safety for the surgical treatment of carpal tunnel syndrome, with no reports of complications.

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          Most cited references28

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          A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase.

          To examine prospectively the incidence of digital infarction and phentolamine rescue in a large series of patients in whom local anesthesia with adrenaline was injected electively into the hand and fingers. There continues to be a commonly held belief that epinephrine injection is contraindicated in the finger despite a lack of valid evidence to support this concept in the literature. From 2002 to 2004 there were 9 hand surgeons in 6 cities who prospectively recorded each consecutive case of elective hand and finger epinephrine injection. They recorded each instance of skin or tissue loss and the number of times phentolamine reversal of adrenaline vasoconstriction was required. There were 3,110 consecutive cases of elective injection of low-dose epinephrine (1:100,000 or less) in the hand and fingers and none produced any instance of digital tissue loss. Phentolamine was not required to reverse the vasoconstriction in any patients. The true incidence of finger infarction in elective low-dose epinephrine injection into the hand and finger is likely to be remote, particularly with the possible rescue with phentolamine.
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            Dosage of local anesthesia in wide awake hand surgery.

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              A comprehensive review of epinephrine in the finger: to do or not to do.

              The prohibition against the use of local anesthetics with epinephrine for digital blocks or infiltration is an established surgical tradition. The present article provides a comprehensive review of all reported digital necrotic and ischemic complications with epinephrine in the digits in an effort to understand whether the current prohibition is based on documented reports. A comprehensive review of articles showing the successful use of local anesthetic with epinephrine in the digits is presented.A review of Index Medicus from 1880 to 1966 and a computer review of the National Library of Medicine database from 1966 to 2000 were performed using multiple keywords. Selected major textbooks from 1900 to 2000 were also reviewed.A total of 48 cases of digital gangrene after anesthetic blocks (mostly using cocaine or procaine) have been reported in the world literature. Only 21 cases involved the use of epinephrine; 17 involved an unknown concentration based on manual dilution. Multiple other concurrent conditions (hot soaks, tight tourniquets, and infection) existed in these case reports, making it difficult to determine the exact cause of the tissue insult. There have been no case reports of digital gangrene using commercial lidocaine with epinephrine (introduced in 1948). Multiple studies involving thousands of patients support the premise that the use of lidocaine with epinephrine is safe in the digits. An extensive literature review failed to provide consistent evidence that our current preparations of local anesthesia with epinephrine cause digital necrosis, although not all complications are necessarily reported. However, as with all techniques, caution is necessary to balance the risks of this technique with the dangers of mechanical tourniquets and upper extremity block anesthesia.
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                Author and article information

                Journal
                rbcp
                Revista Brasileira de Cirurgia Plástica
                Rev. Bras. Cir. Plást.
                Sociedade Brasileira de Cirurgia Plástica (São Paulo, SP, Brazil )
                1983-5175
                2177-1235
                March 2022
                : 37
                : 1
                : 94-99
                Affiliations
                [3] Pelotas Rio Grande do Sul orgnameUniversidade Católica de Pelotas Brazil
                [1] Rio Grande Rio Grande do Sul orgnameUniversidade Federal do Rio Grande orgdiv1Hospital Universitário Dr Miguel Riet Correa Jr orgdiv2Unidade Músculo Esquelética Brazil
                [2] Rio Grande Rio Grande do Sul orgnameUniversidade Federal do Rio Grande orgdiv1Faculdade de Medicina Brazil
                Article
                S1983-51752022000100094 S1983-5175(22)03700100094
                10.5935/2177-1235.2022rbcp0016
                46c29d92-bfa2-4576-a0d2-6d803f926ccf

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 28 March 2021
                : 14 July 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 6
                Product

                SciELO Brazil

                Categories
                Artigo de Revisão

                Lidocaine,Síndrome do túnel carpal,Neuropatia mediana,Epinefrina,Lidocaína,Anestesia,Carpal tunnel syndrome,Median neuropathy,Epinephrine,Anesthesia

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