metaanalysis on Wide awake local anes.pptx

Metaanalysis journal review
Wide Awake Local Anesthesia NO torniquet

1. The Journal of Hand Surgery (Asian-Pacific Volume) 2019

2. INTRODUCTION PURPOSE To compare outcomes of atraumatic hand surgeries using the WALANT technique versus intravenous regional anesthesia or local anesthesia with tourniquet. The p urpose of this study is to identify and synthesize studies comparing the abovementioned techniques, particularly in terms of functional outcomes, patient satisfaction, operative time, post-operative pain scores and complications.

3. I. APPRAISING DIRECTNESS ACTUAL CLINICAL PROBLEM RESEARCH QUESTION ARTICLE PATIENT 51/F Atraumatic hand disease Flexor tenosynovitis Adult patients > 18 Atraumatic hand disease POPULATION INTERVENTION WALANT with no torniquet WALANT no torniquet INTERVENTION COMPARATOR Local anesthesia without torniquet Local anesthesia or IV regional anesthesia with torniquet COMPARATOR OUTCOME Functional outcome Patient satisfaction Operative time Post op pain Complication Functional outcome Patient satisfaction Operative time Post op pain Complication OUTCOMES Systematic review and metanalysis METHOD

4. II. VALIDITY APPRAISAL INCLUSION CRITERIA Population: Adult patients (≥ 18 years old) diagnosed to have atraumatic hand disease undergoing elective hand surgeries Intervention: WALANT (local anesthesia and adrenaline, no tourniquet), Comparator: local anesthesia or IV regional anesthesia with tourniquet Outcomes: functional outcomes, patient satisfaction, operative time, post-operative pain scores and complications. Study design: randomized controlled trials (RCTs) or quasi-randomized trial and cohort studies.

5. … A comprehensive literature search using PubMed, MEDLINE, Embase, and Cochrane Library … A comprehensive electronic literature search was conducted in the Cochrane central database from inception to December 2018 for both published and unpublished articles.

6. …Two independent investigators independently extracted the information from the original studies using a standardized data abstraction list …pertinent data was extracted independently by two reviewers from each study and comparisons of results were done.

7. III. RESULTS APPRAISAL (FOREST PLOTS)

8. III. RESULTS APPRAISAL (FOREST PLOTS)

9. III. RESULTS APPRAISAL (FOREST PLOTS)

10. IV. APPLICABILITY TO PATIENT 51F Atraumatic injury WALANT Patient compliance Treatmen t provider capacity

11. CONCLUSION The WALANT group reported lower post-operative pain scores, but had slightly longer operative times. There are no significant differences between WALANT and conventional methods in terms of patient satisfaction and complication rates.