Amir Adham Ahmad1, Muhammad Abu Ubaidah Mustapa Kamal2, Shairil Rahayu Ruslan3, Shalimar Abdullah4, Abdul Rauf Ahmad2. 1. Department of Orthopaedic, International Medical University, Seremban, Negeri Sembilan, Malaysia. Electronic address: amir_adham@yahoo.com. 2. Department of Orthopaedic, Hospital Tuanku Ja'afar Seremban, Seremban, Negeri Sembilan, Malaysia. 3. Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 4. Department of Orthopaedic, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Abstract
BACKGROUND: Fixation of clavicle fractures has now become a more popular option as it provides better outcome compared with conservative management. Wide-awake local anesthesia no tourniquet (WALANT) has been effectively used in plating of distal radius and olecranon fractures. This paper expands the usage of WALANT into the shoulder girdle, namely plating of the clavicle that has not been described. The operation is typically performed under general anesthesia. METHODS: We report a case series of 16 patients who successfully underwent fixation of the clavicle under the wide-awake technique. The clavicle fractures were grouped under the AO Fracture Classification. The WALANT solution comprised 1% lidocaine, 1:100,000 epinephrine, and 10:1 sodium bicarbonate. A total of 40 mL was injected in each patient with 10 mL subcutaneously along the clavicle followed by 30 mL subperiosteally at multiple intervals and directions. RESULTS: The Numerical Pain Rating Score was 0 during WALANT injection and during surgery except for 2 patients with Numerical Pain Rating Scores of 1 and 2, respectively, during reduction. CONCLUSION: We conclude that clavicle plating under WALANT is a good alternative option of anesthesia.
BACKGROUND: Fixation of clavicle fractures has now become a more popular option as it provides better outcome compared with conservative management. Wide-awake local anesthesia no tourniquet (WALANT) has been effectively used in plating of distal radius and olecranon fractures. This paper expands the usage of WALANT into the shoulder girdle, namely plating of the clavicle that has not been described. The operation is typically performed under general anesthesia. METHODS: We report a case series of 16 patients who successfully underwent fixation of the clavicle under the wide-awake technique. The clavicle fractures were grouped under the AO Fracture Classification. The WALANT solution comprised 1% lidocaine, 1:100,000 epinephrine, and 10:1 sodium bicarbonate. A total of 40 mL was injected in each patient with 10 mL subcutaneously along the clavicle followed by 30 mL subperiosteally at multiple intervals and directions. RESULTS: The Numerical Pain Rating Score was 0 during WALANT injection and during surgery except for 2 patients with Numerical Pain Rating Scores of 1 and 2, respectively, during reduction. CONCLUSION: We conclude that clavicle plating under WALANT is a good alternative option of anesthesia.
Authors: Homid Fahandezh-Saddi Díaz; Fátima Bebea Zamorano; Jorge Enrique Ruiz Zafra; Antonio Ríos Luna; María Elena Cantero Yubero; Donald H Lalonde Journal: Plast Reconstr Surg Glob Open Date: 2022-09-14