Wide Awake Technique versus Local Anesthesia with
Tourniquet Application for Minor Orthopedic Hand
Surgery: A Prospective Clinical Trial
Sompob Ruxasagulwong MD*,
Jirachart Kraisarin MD*, Kanit Sananpanich MD*
Affiliation :
* Hand and Microsurgery Unit, Department of Orthopaedics, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
Background : Most minor hand operations can be performed with local anesthesia and tourniquet. Some literature supports
this concept based on the believe that the “patient can tolerate it”. Nowadays, the wide-awake technique with epinephrine-
contained lidocaine is safe. This technique does not need a tourniquet because epinephrine provides local vasoconstriction.
Objective : The present study was designed to compare patients’ comfort and effectiveness of local anesthesia as well as
bleeding at the surgical site between wide-awake anesthesia and local lidocaine with tourniquet application.
Material and Method: Prospective Clinical Trial was performed in 60 patients who received outpatient surgery for common
hand problems at Maharaj Nakorn Chiang Mai Hospital. With randomization, 30 patients were in wide-awake group, who
received adrenaline-contained lidocaine as a local anesthetic agent, with tourniquet wrapping but with no pressure applied
(group 1). The other 30 patients were in the conventional group that received lidocaine (no adrenaline) and a 250-mmHg
tourniquet application (group 2). Operations were performed with standard methods. Visual analog scores, surgical field
bleeding, amount of bleeding, any complications within 4 weeks were recorded.
Results : There are no significant differences between the two groups in terms of patient profiles (sex, age and diseases),
injected site pain and surgeon’s opinion of surgical site bleeding. Tourniquet’s pain and the amount of blood loss in the
conventional group were significantly higher than the wide-awake group.
Conclusion : Wide-awake technique (no tourniquet applied) offers better comfort for patients and less total blood loss while
providing effective anesthesia and patient safety as with the conventional technique.
Keywords : Wide-awake anesthesia, Carpal tunnel syndrome, Trigger finger, De Quervain’s tenosynovitis, Tourniquet arm pain
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