title: Wide awake technique versus local anesthesia with tourniquet application for minor orthopedic hand surgery: a prospective clinical trial.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Sompob
authors.initials: S
authors.lastname: Ruxasagulwong
authors.forename: Jirachart
authors.initials: J
authors.lastname: Kraisarin
authors.forename: Kanit
authors.initials: K
authors.lastname: Sananpanich
mesh_terms: D000556:Ambulatory Surgical Procedures; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016063:Blood Loss, Surgical; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014111:Tourniquets; D064232:Visual Analog Scale
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D008012:Lidocaine; D004837:Epinephrine