Evaluation of Postoperative Experience of Two WALANT-type Modes of Anesthesia (Lidocaine Alone or Combined With Ropivacaine) Used in Ambulatory Surgery of the Upper Limb. A Single-center Prospective Randomized, Single-blind Study

NIMAO/2021-1/YG-01

Distal surgery of the upper limb under local anesthesia using the WALANT technique (Wide Awake Local Anesthesia No Tourniquet) has become the standard care in orthopedic surgery. The principle is that the operator infiltrates the whole surgical area with a 1% lidocaine solution combined with adrenaline (diluted to 1/200,000) so that all distal surgery of the upper limb can be performed without a tourniquet. Thus, the perioperative course and management of the patient in the operating room and the constraints inherent to general anesthesia are largely reduced. Also, the material cost is considerably reduced. However, WALANT often induces significant pain when the patient leaves the operating room to return home. This effect is related to the pharmacological formulation of lidocaine which has a short half-life (\< 3h). To reduce this inconvenience of early block removal, adding a local anesthetic with a longer duration of action (ropivacaine) to lidocaine would extend the duration of the analgesic, improving postoperative experience and satisfaction. The main objective of this research is to evaluate the effect of two WALANT anesthesia protocols (with or without the addition of ropivacaine) on the postoperative experience of patients (QoR-40 questionnaire) 48 hours after outpatient hand surgery.

2022-05-30

2023-06-25

2023-09-25

Completed

Early phase I

91

Inclusion Criteria: * Patient eligible for outpatient surgery under WALANT for: * Hand surgery such as carpal tunnel, stub finger, Dupuytren's disease; * Elbow surgery such as ulnar nerve compression and lacertus fibrosus syndrome. * Patient with free and informed consent. * Patient with signed consent form. * Patient affiliated to or beneficiary of a health insurance plan. Exclusion Criteria: * Ischemic vascular disorders such as severe Raynaud's disease, Buerger's disease, diabetic microangiopathy. * Scleroderma. * Known allergy to ropivacaine or lidocaine and possibility of cross-allergy with other amide-bound local cross-allergy with other local anesthetics with amide linkage. * Severe hepatic impairment * Acute porphyria. * Intravascular anesthesia. * Anesthesia by local infiltration in the extremities * Coronary insufficiency. * Ventricular rhythm disorders. * Severe arterial hypertension. * Obstructive cardiomyopathy. * Hyperthyroidism. * Hypovolemia.

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2023-11-27