Lalonde Wide Awake Hand Surgery and Therapy Tips

2. Auflage 2021
ISBN: 978-1-63853-503-4
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 474 Seiten, ePub

Reihe: Thieme Medical Publishers

WALANT (Wide Awake Local Anesthesia No Tourniquet) eliminates the need for preoperative testing, sedation, intravenous insertion, and monitoring in upper and lower limb surgery. Coupled with minimal pain injection techniques using pure local anesthesia with lidocaine and epinephrine, this technique has significantly improved hand surgery for patients and surgeons in many ways. , provides readers with the best and latest WALANT advances from Donald H. Lalonde and an impressive group of hand surgeons from 15 countries that have incorporated this groundbreaking technique into practice to benefit their patients. Each richly illustrated chapter encompasses evidence-based benefits, step-by-step guidance, patient education tips, detailed injection directions, surgery and therapy tips and tricks, postsurgical management, and related videos.

WALANT produces better outcomes in flexor and extensor tendon repair, tendon transfer, tenolysis, tendon grafts, and finger fracture surgery because unsedated patients can easily move reconstructed parts during surgery. This allows surgeons to make required adjustments and teach patients uninterrupted while they are awake. Eliminating sedation also decreases risks, increases patient safety, and reduces pain associated with intravenous insertion. Simple surgeries such as trigger finger and carpal tunnel release no longer require costly main operating rooms. Instead, they can be performed in minor procedure rooms with evidence-based sterility, resulting in lower costs and reduced waste.

New Features

• A three times larger video library with more than 500 videos, most of which are new
• New chapters on upper and lower limb fracture plating of the wrist, forearm, elbow, acromion, clavicle, tibia, fibula, ankle, and foot
• More than eight hours of video education covering ultrasound hand diagnosis and ultrasoundguided surgery
• Innovative hand therapy techniques made possible by WALANT detailed under Therapy Tips
• The use of pencil test and relative motion splinting to resolve numerous hand problems
• New strategies to implement WALANT in hospitals

This must-have resource will help hand surgeons, hand therapists, and allied nurses prevent unnecessary costs and risks, reduce complications, and improve patient outcomes.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Autoren/Hrsg.

Lalonde, Donald

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Orthopädie- und Unfallchirurgie

Inhaltsverzeichnis

Section I Atlas of Tumescent Local Anesthesia Elbow, Forearm, Wrist, Hand, and Finger Injections
1 Finger Blocks and Atlas of Images of Tumescent Local Anesthetic Diffusion Anatomy
Section II General Principles of Wide Awake Hand Surgery
2 Advantages of WALANT for Patients, Surgeons, and Anesthesiologists
3 Safe Epinephrine in the Finger Means No Tourniquet
4 On Using Tumescent Local Anesthesia
5 How to Inject Local Anesthetic So That It Does Not Hurt
6 Dealing with Systemic Adverse Reactions to Lidocaine and Epinephrine
7 Tips on Explaining WALANT to Patients before Surgery
8 Teaching Patients and Residents during Surgery Decreases Complications
9 Tips on Good Local Anesthesia in Infants and Children
10 Moving Surgery out of the Main Operating Room with Evidence-Based Field Sterility
11 WALANT and Value in Health Care: Improving Outcomes and Lowering Cost
12 WALANT and "The Why": Administration, Anesthesiology, Nursing, and Payers
13 Performing Your First Cases with WALANT
14 How to Schedule 15 or More Hand Surgery Cases per Day with One Nurse
15 Integrating Hand Therapists into WALANT
16 Minor Procedure Room Setup
Section III Details of How to Do WALANT and Therapy Tips for the Upper Extremity

17 Trigger Finger
18 De Quervain's Release

19 Flexor Tendon Repair of the Finger
20 Flexor Tendon Repair of the Hand, Wrist, and Forearm
21 Extensor Tendon Repair of the Finger (Zone 1 Mallet to Zone 5 MP Joint)
22 Extensor Tendon Repair of the Hand, Wrist, and Forearm (Zones 6 to 8)

23 Tenolysis

24 Tendon Transfers

25 Tendon Grafts and Pulley Reconstruction

26 Carpal Tunnel Decompression of the Median Nerve
27 Cubital Tunnel Decompression of the Ulnar Nerve
28 Lacertus Syndrome: Median Nerve Release at the Elbow
29 Radial and Peroneal Nerve Decompression
30 Simultaneous Release of Carpal Tunnel with Cubital Tunnel or Lacertus
31 Lacerated Nerves

32 Dupuytren's Contracture
33 Ganglions and Other Small Soft Tissue Operations
34 Flap Harvest and Transfer in the Hand
35 Infection Surgery, Compartment Syndrome Release, and Tibial Hematoma Drainage

36 Finger Joint Arthroplasty, Fusion, and Ligament Repair
37 Thumb Metacarpophalangeal Joint Fusion and Ulnar Collateral Ligament Repair

38 Trapeziectomy with or without Ligament Reconstruction for Thumb Basal Joint Arthritis
39 Wrist Arthroscopy
40 Wrist Arthritis Surgery

41 Finger Fractures
42 Metacarpal Fractures
43 Wrist Fracture and Ligament Injuries
44 Distal Radius and Forearm Fractures
45 Surgery around the Elbow
46 Clavicle and Acromion Fractures

47 Finger and Ray Amputation
48 Replantation

49 What You Need to Know about the Basics of Using Ultrasound for WALANT Hand Surgery
50 Ultrasound-Assisted Upper Extremity Procedures
Section IV WALANT Lower Extremity Surgery
51 Patella Fractures
52 Tibia and Fibula Fractures
53 Foot and Ankle Fractures and Surgery
Section V Pencil Test and Relative Motion Splinting to Solve Hand Pain Problems and Improve Range of Motion in Stiff Fingers
54 Pencil Test and Relative Motion Splinting to Solve Hand Pain and Stiffness after Trauma and Surgery

Leseproben

Video Contents

SECTION IATLAS OF TUMESCENT LOCAL ANESTHESIA ELBOW, FOREARM, WRIST, HAND, AND FINGER INJECTIONS

1Finger Blocks and Atlas of Images of Tumescent Local Anesthetic Diffusion Anatomy

Donald H. Lalonde

Video 1.1How to inject a minimally painful, evidence-based SIMPLE digital block.

Video 1.2How the two dorsal injections web space block got replaced by the single-injection SIMPLE digital block.

SECTION IIGENERAL PRINCIPLES OF WIDE AWAKE HAND SURGERY

2Advantages of WALANT for Patients, Surgeons, and Anesthesiologists

Alistair Phillips, Nikolas Alan Jagodzinski, Yin-Ming Huang, and Donald H. Lalonde

Video 2.1An introduction to wide awake hand surgery.

Video 2.2Safer surgery without sedation in an oxygenated patient who could not sleep before surgery because of carpal tunnel pain. He had surgery sitting up on his oxygen like going to the dentist and then went home. He was able to sleep better for the last 6 months of his life when he died of pulmonary disease.

Video 2.3Patient’s perspective of wide awake hand surgery.

Video 2.4Surgeon puts a tourniquet on his own arm to see what it feels like.

Video 2.5Washing a contaminated hand in a wide awake patient in the emergency department with tap water.

Video 2.6An upper extremity block specialist anesthesiologist, who uses WALANT routinely, discusses where it fits in his practice.

3Safe Epinephrine in the Finger Means No Tourniquet

Donald H. Lalonde, Robert E. Van Demark, Jr., and Chris Chun-Yu Chen

Video 3.1History of the rise and fall of the epinephrine danger myth (Lalonde, Canada).

Video 3.2How ro reverse epinephrine vasoconstriction with phentolamine injection in the finger (Lalonde, Canada).

Video 3.3How to reverse finger epinephrine vasoconstriction after accidental intrasheath injection if you got a white finger for trigger finger surgery (Lalonde, Canada).

Video 3.4Phentolamine reversal of epinephrine vasoconstriction the morning after epinephrine injection (Van Demark, Jr., USA).

Video 3.5Loss of hemi-fingertip in a Raynaud’s patient in spite of phentolamine rescue (Lalonde, Canada).

4On Using Tumescent Local Anesthesia

Donald H. Lalonde, Amir Adham Ahmad, and Alistair Phillips

Video 4.1Principles of tumescent local anesthesia.

5How to Inject Local Anesthetic So That It Does Not Hurt

Donald H. Lalonde

Video 5.1The 2015 story of how Don Lalonde came to stop hurting people after 22 years of painful local anesthesia injections.

Video 5.2How not to hurt people when you inject local anesthesia.

Video 5.3Pinching the skin into the needle instead of pushing the needle into the skin.

Video 5.4Sensory noise when there is not enough skin to pinch.

Video 5.5Blow slow before you go.

Video 5.6Explaining pain scoring to patients so they can help you get better at hurting less every time you inject.

Video 5.7Always reinsert the needle at least 1 cm inside the blanched (swollen)/unblanched (not swollen) border so they never feel it.

Video 5.8Cannula injection of tumescent local anesthetic for synovectomy and tendon transfer.

6Dealing with Systemic Adverse Reactions to Lidocaine and Epinephrine

Donald H. Lalonde

Video 6.1Managing the patient who is going to faint.

7Tips on Explaining WALANT to Patients before Surgery

Nikolas Alan Jagodzinski, Alistair Phillips, and Donald H. Lalonde

Video 7.1Explaining WALANT to a patient.

Video 7.2More things to tell patients to remove fear of the unknown.

Video 7.3Patient compares the pain of trapeziectomy local anesthesia injection to the pain of intravenous line insertion.

8Teaching Patients and Residents during Surgery Decreases Complications

Donald H. Lalonde and Duncan McGrouther

Video 8.1Advice to patient during skin cancer excision in the hand.

Video 8.2Advice to patient during prepping for a hand fracture pinning.

Video 8.3aExplaining how to take pain medicine after carpal tunnel surgery to avoid the need for narcotics.

Video 8.3bExplaining how to take post-op pain medication during Dupuytren’s surgery.

Video 8.4Intraoperative advice on showering and bandaging after carpal tunnel, trigger finger.

Video 8.5Intraoperative advice to a 10-year-old on how to look after her hand after surgery (for more on this patient, see Video 9.3).

Video 8.6Intraoperative education to patient having distal interphalangeal (DIP) joint fusion.

Video 8.7Patient’s impression of intraoperative education after initial fear of being awake.

9Tips on Good Local Anesthesia in Infants and Children

Donald H. Lalonde, Geoffrey Cook, Steven Koehler, and Chao Chen

Video 9.1Local injection in the thumb of a 4-year-old girl (Lalonde, Canada).

Video 9.2Flexor tendon repair in a 6-year-old girl with patient impressions at 13 years of age (Lalonde, Canada).

Video 9.3Explaining “magic medicine” injection of local anesthesia to an 8-year-old for redo trigger thumb (Lalonde, Canada).

Video 9.4Talking to the 8-year-old in Video 9.3 during the surgery so that she is comfortable (Lalonde, Canada).

Video 9.5Postoperative advice given to the mother and 8-year-old in Video 9.3 during the surgery (Lalonde, Canada).

Video 9.6Flexor tendon injection in a 10-year-old (Lalonde, Canada).

Video 9.7Details of local anesthesia to remove extra digits in newborn (both hands and feet in this case) (Lalonde, Canada).

Video 9.8Excision of a fifth finger nubbin in a 4-week-old baby (Lalonde, Canada).

Video 9.9Extensor tendon repair in 7-year-old and patient’s impressions 10 years later (Cook, Canada).

Video 9.10Plating mid radius and ulna fractures in a 12-year old (Koehler, USA).

Video 9.11Tenolysis in a 4-year-old distracted by a video on a phone (Chen, China).

10Moving Surgery out of the Main Operating Room with Evidence-Based Field Sterility

Donald H. Lalonde, Nikolas Alan Jagodzinski, and Robert E. Van Demark, Jr.

Video 10.1Safety and value of field sterility for minor hand surgery.

11WALANT and Value in Health Care: Improving Outcomes and Lowering Cost

Peter J. L. Jebson, Kevin T. K. Chan, Levi L. Hinkelman, Daniel Hess, Robert E. Van Demark, Jr., Mark Baratz, Leigh-Anne Tu, and Donald H. Lalonde

Video 11.1The economics of WALANT surgery compared to traditional tourniquet surgery with sedation.

Video 11.2The decreased costs of scheduling WALANT surgery compared to traditional tourniquet surgery with sedation.

12WALANT and “The Why”: Administration, Anesthesiology, Nursing, and Payers

Peter J. L. Jebson, Kevin T. K. Chan, Levi L. Hinkelman, Daniel Hess, Julie E. Adams, Michael W. Neumeister, Robert E. Van Demark, Jr., Peter C. Amadio, and Donald H. Lalonde

Video 12.1First impressions of a new WALANT procedure room in Sioux Falls, South Dakota, USA.

Video 12.2Initially skeptical patient’s impression of WALANT tendon repair.

Video 12.3An anesthesiologist who uses WALANT routinely discusses where it fits in his practice.

13Performing Your First Cases with WALANT

Andrew W. Gurman, Robert E. Van Demark, Jr., Günter Germann, Jason Wong, and Donald H. Lalonde

Video 13.1Injection of lidocaine with epinephrine as soon as the patient is asleep with general anesthesia for no tourniquet surgery.

14How to Schedule 15 or More Hand Surgery Cases per Day with One Nurse

Donald H. Lalonde

Video 14.1Patient education during painless carpal tunnel injection: part 1.

Video 14.2Patient education during second half of painless carpal tunnel injection.

Video 14.3Four patients waiting for local anesthesia to work while reading postoperative instructions.

15Integrating Hand Therapists into WALANT

Amanda Higgins, Lisa Flewelling, Susan Kean, and Donald H....