الفهرس 
ANATOMY OF THE HANDOnly 14 pages are availabe for public view
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Abstract
SUMMARY
F
lexor tendon injuries represents a significant percentage of admissions in emergency departments in Egypt, what we witness in daily practice in emergency theaters suggests this.
A bloodless surgical field is important in order to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the well-established anesthetic techniques utilised in hand surgery; Intravenous Regional Anesthesia (IVRA) and General Anesthetic (GA), sedation, brachial plexus or Bier block.
In times of the COVID-19 pandemic, and to avoid its other risks, it’s better to avoid GA, and by comparing other options of regional anesthesia, brachial plexus block found to be the best.
WALANT in which lidocaine and epinephrine are injected for local anesthesia and vasoconstriction, respectively, has been increasingly used for hand surgeries, having advantages over both IVRA and IC-BPB in terms of cost of anesthesia.
Aim of this work was to compare the intraoperative pain scores, secondary, is to compare induction time, operating time, blood loss, postoperative pain scores and patient’s satisfaction with WALANT versus supraclavicular brachial plexus block with tourniquet, in patients undergoing flexor tendon repair.
In the current study 52 patients who underwent flexor tendon intervention were included. Patients were divided randomly into two groups, each group consisted of 26 patients.
group A: Patients in this group received WALANT.
group B: Patients in this group received SC-BPB with tourniquet applied to the arm.
As regard the parameters recorded in the current study, intraoperative Wong-Baker Facies scale revealed there was no statistically significant difference in intraoperative pain scores reported in both groups except during injection. Tourniquet related pain reported in some patients of SC-BPB group.
Induction time was significantly shorter in WALANT but time needed to obtain sufficient hemostasis is significantly more in WALANT than SC-BPB and surgical time was similar in both groups.
Blood loss in spite of being minimal it was statistically significant higher in WALANT.
There was no statistically significant difference in the post-operative pain score in both groups in the first 6 hours, then the pain perceived was significantly higher in SC-BPB group when measured 8,10 and 12 hours post operatively.
In the current study, time to rescue analgesia was similar in both groups but the total analgesic consumption in the 1ST twelve hours post-operative was significantly less in WALANT.
Brachial plexus block need a lot of preparations, Laboratory investigations, ultrasound guidance and highly skilled hands to avoid serious potential side effects; which is not always available unlike WALANT, also WALANT scored more patient and surgeon satisfaction than SC-BPB.