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Authors
Abstract(s)
Introdução: A técnica de anestesia “Wide Awake Local Anesthesia No Tourniquet”
WALANT em cirurgia da mão destaca-se pela vantagem de ser administrada sem a
necessidade de sedação e sem o uso de um garrote. Permite ao doente permanecer acordado
e mobilizar os dedos durante a operação. Estudos recentes destacam a sua segurança,
satisfação do doente e revelam benefícios económicos consideráveis. Esta revisão visa
explorar se a técnica anestésica WALANT em cirurgias da mão é uma abordagem com custobenefício em comparação com outras técnicas.
Métodos: Foi realizada uma revisão sistemática da literatura sobre as vantagens
económicas da técnica de WALANT na cirurgia da mão, tendo como base as Guidelines
PRISMA 2020.Foram utilizadas as bases de dados PubMed/MEDLINE, Science Direct,
Scopus e Web of Science, com a equação (“walant” OR ”wide awake” OR “no tourniquet” OR
“local anestesia” OR “tumescent anestesia”) AND (“cost” OR “economic”) . Foram
selecionados os artigos que apresentavam uma análise comparativa entre WALANT e outras
técnicas anestésicas para procedimentos cirúrgicos da mão em adultos e que abordavam os
respetivos custos. Excluíram-se os estudos que não especificavam o tipo de anestesia local,
que não utilizavam WALANT e que não apresentavam valores concretos dos gastos. O
principal objetivo foi a avaliação do custo-benefício da técnica de WALANT e os objetivos
secundários incluíram o tempo associado a cada procedimento e a produção de resíduos
hospitalares.
Resultados: No total, foram encontrados 3417 artigos nas quatro das bases de dados e
selecionados 22. Entre as condições patológicas, 13 artigos abordam a Síndrome do Túnel
do Carpo, oito o dedo em gatilho, quatro a doença de Dupuytren, quatro procedimentos
ósseos, três a síndrome de De Quervain e dois a excisão de quistos sinoviais. Quanto à
variável custo-benefício, 20 artigos demonstraram diferenças estatisticamente
significativas entre WALANT e outras técnicas anestésicas. Relativamente ao tempo, há
evidências de uma redução significativa do tempo total no bloco operatório com WALANT.
Está associada a menos tempo na unidade de cuidados pós anestésicos e a menos tempo de
turnover entre doentes. No que diz respeito aos resíduos, também permite uma redução
significativa da sua produção.
Conclusão: Os resultados desta revisão indicam que a técnica WALANT demonstra
vantagens económicas, pode contribuir para otimizar recursos e reduzir listas de espera,
alinhando-se com o crescente interesse dos sistemas de saúde em fornecer cuidados de alto
valor. No entanto, persistem desafios na superação da resistência à sua adoção, e destacase a necessidade de estudos mais detalhados e uniformização de ferramentas de avaliação
em Portugal.
Introduction: The "Wide Awake Local Anaesthesia No Tourniquet" (WALANT) technique in hand surgery stands out for its advantage of being administered without the need for sedation and without the use of a tourniquet. It allows the patient to remain awake and mobilize the fingers during the operation. Recent studies highlight its safety, patient satisfaction, and reveal considerable economic benefits. This review aims to explore whether the WALANT anaesthetic technique in hand surgeries is a cost-benefit approach compared to other techniques. Methods: A systematic literature review on the economic advantages of the WALANT technique in hand surgery was conducted, based on the PRISMA 2020 guidelines. The PubMed/MEDLINE, Science Direct, Scopus, and Web of Science databases were searched using the equation ("walant" OR "wide awake" OR "no tourniquet" OR "local anesthesia" OR "tumescent anesthesia") AND ("cost" OR "economic"). Articles were selected that presented a comparative analysis between WALANT and other anaesthetic techniques for hand surgical procedures in adults and addressed their respective costs. Studies that did not specify the type of local anaesthesia, did not use WALANT, and did not provide specific cost values were excluded. The primary objective was the assessment of the cost-benefit of the WALANT technique, with secondary objectives including the time associated with each procedure and the production of hospital waste. Results: A total of 3417 articles were found in the four databases, with 22 selected. Among the pathological conditions, 13 articles addressed Carpal Tunnel Syndrome, eight Trigger Finger, four Dupuytren's Disease, four bone procedures, three De Quervain's Syndrome, and two synovial cyst excisions. Regarding the cost-effectiveness variable, 20 articles demonstrated statistically significant differences between WALANT and other anaesthetic techniques. Concerning time, there is evidence of a significant reduction in total operating room time with WALANT. It is associated with less time in the post-anaesthesia care unit and less turnover time between patients. Regarding waste, it also allows for a significant reduction in its production. Conclusion: The results of this review indicate that the WALANT technique demonstrates economic advantages, may contribute to optimizing resources and reducing waiting lists, aligning with the growing interest of healthcare systems in providing high-value care. However, challenges persist in overcoming resistance to its adoption, highlighting the need for more detailed studies and standardization of assessment tools in Portugal.
Introduction: The "Wide Awake Local Anaesthesia No Tourniquet" (WALANT) technique in hand surgery stands out for its advantage of being administered without the need for sedation and without the use of a tourniquet. It allows the patient to remain awake and mobilize the fingers during the operation. Recent studies highlight its safety, patient satisfaction, and reveal considerable economic benefits. This review aims to explore whether the WALANT anaesthetic technique in hand surgeries is a cost-benefit approach compared to other techniques. Methods: A systematic literature review on the economic advantages of the WALANT technique in hand surgery was conducted, based on the PRISMA 2020 guidelines. The PubMed/MEDLINE, Science Direct, Scopus, and Web of Science databases were searched using the equation ("walant" OR "wide awake" OR "no tourniquet" OR "local anesthesia" OR "tumescent anesthesia") AND ("cost" OR "economic"). Articles were selected that presented a comparative analysis between WALANT and other anaesthetic techniques for hand surgical procedures in adults and addressed their respective costs. Studies that did not specify the type of local anaesthesia, did not use WALANT, and did not provide specific cost values were excluded. The primary objective was the assessment of the cost-benefit of the WALANT technique, with secondary objectives including the time associated with each procedure and the production of hospital waste. Results: A total of 3417 articles were found in the four databases, with 22 selected. Among the pathological conditions, 13 articles addressed Carpal Tunnel Syndrome, eight Trigger Finger, four Dupuytren's Disease, four bone procedures, three De Quervain's Syndrome, and two synovial cyst excisions. Regarding the cost-effectiveness variable, 20 articles demonstrated statistically significant differences between WALANT and other anaesthetic techniques. Concerning time, there is evidence of a significant reduction in total operating room time with WALANT. It is associated with less time in the post-anaesthesia care unit and less turnover time between patients. Regarding waste, it also allows for a significant reduction in its production. Conclusion: The results of this review indicate that the WALANT technique demonstrates economic advantages, may contribute to optimizing resources and reducing waiting lists, aligning with the growing interest of healthcare systems in providing high-value care. However, challenges persist in overcoming resistance to its adoption, highlighting the need for more detailed studies and standardization of assessment tools in Portugal.
Description
Keywords
(Termos Decs): Análise Custo-Benefício Anestesia Local Procedimentos Ortopédicos Torniquetes