Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V... · 2026
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Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Kluwe Lara-Sophie, Weichenthal Jene, Navarro Luis Barros, Gulbis Niks, Suhr Laura Maria, Milewski Moritz Rudolf, Lorbeer Lisa, Obed Doha, Vogt Peter M, Enechukwu Anieto Onochie Matthias
Аннотация
INTRODUCTION: Wide Awake Local Anesthesia No Tourniquet (WALANT) is an established method of local anesthesia in hand surgery. In rare cases, ischemic complications may occur due to the adrenaline contained in the tumescent solution. The vasoconstrictive effect of adrenaline can be antagonized by the local injection of phentolamine. To date, little is known in Germany about the incidence and treatment of ischemic complications, as well as the state of knowledge regarding phentolamine.
MATERIAL AND METHODS: An online survey of hand surgeons in Germany was used to evaluate their knowledge of the management and incidence of ischemic complications associated with the use of the WALANT technique in the hand. Among other things, the survey was designed to assess knowledge of and access to phentolamine as an antidote to the adrenaline contained in the WALANT solution.
RESULTS: A total of 124 surgeons participated in the study. 8.3% of the surgeons had experience with ischemic complications when using the WALANT technique. Ischemic complications were observed mainly after surgical annular ligament release, but also after Dupuytren's contracture surgery and carpal tunnel release. In none of the cases was the antidote phentolamine used. 47.7% of the users had no knowledge of the antidote phentolamine, and accordingly, phentolamine was only available in 53.2% of the hospitals. There was an interest in training in the form of continuing education, specialist literature and workshops to improve the use of phentolamine.
CONCLUSION: Although WALANT is recognized as a very safe procedure, ischemic complications can occur in hand surgery in rare cases. The present study shows an insufficient level of knowledge regarding the antidote phentolamine in the treatment of ischemic complications associated with the WALANT technique. Users of the WALANT technique must be familiar with the procedure and its potential risks in order to be able to respond appropriately in an emergency. Even rare complications may, in case of doubt, lead to functional impairment and medikolegal consequences, particularly when phentolamine is not available. We therefore recommend always maintaining a stock of phentolamine and providing regular training sessions to ensure optimal patient safety.
MATERIAL AND METHODS: An online survey of hand surgeons in Germany was used to evaluate their knowledge of the management and incidence of ischemic complications associated with the use of the WALANT technique in the hand. Among other things, the survey was designed to assess knowledge of and access to phentolamine as an antidote to the adrenaline contained in the WALANT solution.
RESULTS: A total of 124 surgeons participated in the study. 8.3% of the surgeons had experience with ischemic complications when using the WALANT technique. Ischemic complications were observed mainly after surgical annular ligament release, but also after Dupuytren's contracture surgery and carpal tunnel release. In none of the cases was the antidote phentolamine used. 47.7% of the users had no knowledge of the antidote phentolamine, and accordingly, phentolamine was only available in 53.2% of the hospitals. There was an interest in training in the form of continuing education, specialist literature and workshops to improve the use of phentolamine.
CONCLUSION: Although WALANT is recognized as a very safe procedure, ischemic complications can occur in hand surgery in rare cases. The present study shows an insufficient level of knowledge regarding the antidote phentolamine in the treatment of ischemic complications associated with the WALANT technique. Users of the WALANT technique must be familiar with the procedure and its potential risks in order to be able to respond appropriately in an emergency. Even rare complications may, in case of doubt, lead to functional impairment and medikolegal consequences, particularly when phentolamine is not available. We therefore recommend always maintaining a stock of phentolamine and providing regular training sessions to ensure optimal patient safety.