Flexor Tendon Injury Clinical Trial
Official title:
Wide-Awake Local Anesthesia No Tourniquet Versus. Local/General Anesthesia for Flexor Tendon Repair
Primary repair for flexor tendon lacerations remain the standard of care. However, despite
recent advances in knowledge of tendon healing, suture material, and post-operative
protocols, outcomes have been reported as fair or poor in 7-20% of patients. Complications
encountered include adhesion formation, development of joint contractures, tendon rupture,
triggering, bow stringing and quadriplegia. Tendon surgery is unique because it should ensure
tendon gliding after surgery Tendon surgery now can be performed under local anesthesia
without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve
vasoconstriction in the area of surgery. This method allows the tendon to move actively
during surgery to test tendon function intraoperatively and to ensure the tendon is properly
repaired before leaving the operating table.
Wide awake hand surgery is well described by its other name, WALANT which stands for wide
awake local anaesthesia no tourniquet. The only two medications most patients are given for
wide awake hand surgery are Lidocaine for anaesthesia and epinephrine for haemostasis. In the
period before 1950, the belief developed among surgeons that epinephrine causes finger
necrosis .The source of the epinephrine myth stemmed from the use of procaine (Novocaine). It
was the only safely injectable local anaesthetic until the introduction of Lidocaine in 1948.
More fingers died from procaine injection alone than from procaine plus epinephrine injection
.no lost finger no case require phentolamine in many studies.
Primary repair for flexor tendon lacerations remain the standard of care. However, despite
recent advances in knowledge of tendon healing, suture material, and post-operative
protocols, outcomes have been reported as fair or poor in 7-20% of patients. Complications
encountered include adhesion formation, development of joint contractures, tendon rupture,
triggering, bowstringing and quadrigia. Tendon surgery is unique because it should ensure
tendon gliding after surgery It has been a standard practice to obtain local or general
anesthesia and apply a tourniquet to perform tendon surgery. However, this practice has been
changed in recent years...
Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting
epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This
method allows the tendon to move actively during surgery to test tendon function
intraoperatively and to ensure the tendon is properly repaired before leaving the operating
table.
The surgeon can inspect for bunching, gapping, and triggering of the repair site in an active
fashion. Thus, an opportunity is available to revise the repair, trim or add extra sutures,
revise pulley reconstruction, or de-bulk tendons before wound closure Wide awake hand surgery
is well described by its other name, WALANT which stands for wide awake local anaesthesia no
tourniquet. The only two medications most patients are given for wide awake hand surgery are
Lidocaine for anaesthesia and epinephrine for haemostasis. In the period before 1950, the
belief developed among surgeons that epinephrine causes finger necrosis .The source of the
epinephrine myth stemmed from the use of procaine (Novocaine).8 It was the only safely
injectable local anaesthetic until the introduction of Lidocaine in 1948. More fingers died
from procaine injection alone than from procaine plus epinephrine injection .no lost finger
no case require phentolamine in many studies.The "smoking gun" paper that established that
procaine was the actual cause of finger deaths published in the Journal of the American
Medical Association that found batches of procaine with a pH of 1 destined for injection into
humans.
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| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT04486053 -
Long-term Results of Pediatric Flexor Tendon Injuries
|
||
| Terminated |
NCT02361814 -
The Effect of Human Amniotic Membrane Allograft on Functional Recovery After Flexor Tendon Repair
|
N/A | |
| Terminated |
NCT02461680 -
Treatment for Partial Lesions of the Fingers Flexor Tendons : Tangential Resection or Direct Suture
|
N/A |