Comparison of the Cost and Efficacy of Axillary Anesthesia and Wide-Awake Anesthesia in Finger Surgeries

Objectives: Wide-awake anesthesia is a type of local anesthesia consisting of a combined application of lidocaine, epinephrine, and bicarbonate and has a wide potential in hand surgery as it offers the advantage of being applied without sedation and without using a tourniquet. In light of recent studies, its use has increased with the disappearance of the belief among surgeons that epinephrine can cause circulatory disturbance in fingers.
Methods: Patients with finger pathologies who were operated upon at the Baltalimani Bone Diseases Teaching and Research Hospital between January 2015 and February 2016 were divided into two groups according to anesthesia type: wide-awake anesthesia and axillary block anesthesia, with 52 patients in each group. Start time of surgery, length of hospital stay, anesthesia cost, and patient satisfaction were compared. For the evaluation of patient satisfaction, the patients were postoperatively asked whether they would accept the same anesthesia method if they had to have the same experience. Each group was further divided into two subgroups: bone interventions (phalangeal fracture, bone biopsy, implant removal, and interphalangeal joint arthrodesis) and soft tissue interventions (digital nerve repair, fingertip local skin flap, flap division, releasing stiff joint, ligament repair, and debridment). Each subgroup included 26 patients.
Results: Sufficient anesthesia to cover the whole duration of surgery was achieved in both the groups. Regarding the question “If you were experiencing the same experience, would you accept the same anesthesia again?” 26 and 33 patients responded positively, 16 and 7 patients repsonded negatively, and 10 and 12 patients remained neutral in the axillary block and wide-awake anesthesia groups, respectively. According to the Social Security Institution data, the average anesthesia cost was 316.1 TL in the axillary block anesthesia group and 25.3 TL in the wide-awake anesthesia group; the average length of hospital stay was 32.9 h in the former and 13.6 h in the latter. Start time of surgery was 34 minutes in axillary block anesthesia and 5.3 minutes in wide-awake anesthesia.
Conclusion: We found that compared with axillary block anesthesia, the length of hospital stay was 19.3 h less and anesthesia cost was 290.8 TL less with wide-awake anesthesia; furthermore, the start time of surgery decreased by 29.7 min with the latter. Moreover, patient satisfaction rate was better in the wide-awake anesthesia group. No bleeding, patient incompatibility, and other complications that might interfere with the surgery were detected.

El Parmaklarýnýn Cerrahisinde Uyanýk Hasta Anestezisinin Aksiller Anestezi ile Karþýlaþtýrýlmasý

Amaç: Uyanýk hasta anestezisi (wide awake anesthesia) hastalara sedasyon yapýlmadan ve turnike kullanýlmadan yapýlan; içeriði lidokain, epinefrin ve bikarbonattan oluþan ve el cerrahisinde geniþ kullaným potansiyeli olan bir lokal anestezi türüdür. Epinefrinin cerrahlar arasýnda parmaklarda dolaþým bozukluðuna yol açabileceði yönündeki inanýþýn son yýllarda yapýlan çalýþmalarla ortadan kalkmasý ile kullanýmý artmýþtýr.
Gereç ve Yöntem: Ocak 2015 ile Þubat 2016 aylarý arasýnda Baltalimaný Kemik Hastalýklarý Eðitim ve Araþtýrma Hastanesi El Cerrahisi kliniðinde uyanýk hasta anestezisi ile ve aksiller anestezi ile gerçekleþtirilen olgularda parmaklarý ilgilendiren hastalýðý olan 52‘þer hastanýn hastanede ameliyata baþlama zamaný, kalýþ süreleri, maliyeti ve hasta memnuniyeti karþýlaþtýrýldý. Hasta memnuniyeti için ameliyat sonrasý hastalara “Bu yaþadýðýn tecrübeyi tekrar yaþaman gerekse ayný anestezi yöntemini kabul eder miydin?” sorusu yöneltildi. Her iki grupta 26’þar adet olguda kemik giriþimleri (falanks kýrýðý, kemik biyopsisi, implant çýkarýmý ve interfalangial eklem artrodez); 26’þar adet olguda yumuþak doku giriþimleri (dijital sinir onarým, parmak ucu flep, flep ayrýmý, eklem kontraktur gevþetme, bað tamiri, debridman) olacak þekilde oluþturuldu.
Bulgular: Her iki gruptaki hastada operasyonu sürdürecek oranda yeterli anestezinin saðlandýðý görüldü. Operasyon sonrasý hastalara “Bu yaþadýðýn tecrübeyi tekrar yaþaman gerekse ayný anestezi yöntemini kabul eder miydin?” sorusu yöneltildiðinde aksiller anestezi grubundaki hastalarýn 26 olumlu, 16 olumsuz, 10 kararsýz olarak; uyanýk hasta anestezisi grubunda ise 33 olumlu, 7 olumsuz, 12 kararsýz olarak gözlendi. Hasta maliyeti (Sosyal Güvenlik Kurumu –SGK- verilerince); aksiller anestezi grubunda ortalama 316.1 TL, uyanýk hasta anestezisi grubunda ortalama 25.3 TL olarak hesaplandý. Hastanede kalýþ süresinin aksiller anestezi grubunda ortalama 32.9 saat, uyanýk hasta anestezisi grubunda ortalama 13.6 saat olduðu belirlendi. Anestezi sonrasý ameliyata baþlama süresinin aksiller anestezi grubunda ortalama 34 dakika, uyanýk hasta anestezisi grubunda ortalama 5.3 dakika olduðu görüldü.
Sonuç: Çalýþmamýzda uyanýk hasta anestezisi kullanarak tedavi ettiðimiz hastalarýn hastanede kalýþ sürelerinde ortalama 19.3 saat azalma; anestezi maliyetinde ise ortalama 290.8 TL azalma tespit edildi. Hastalarýn anestezi sonrasý ameliyata baþlama zamanýnda da ortalama 29.7 dakika düþüþ saðlandý. Hasta memnuniyeti oraný uyanýk hasta grubunda daha fazlaydý. Hastalarda operasyona mani olacak kanama, hasta uyumsuzluðu ve diðer ek komplikasyonlara da rastlanmadý.