Wrist Arthroscopy under Portal Site Local Anesthesia (PSLA) without Tourniquet
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AbstractPurpose 
wrist arthroscopy is typically performed under general or regional anesthesia with the aid of a tourniquet to maintain a bloodless field. We have been using portal site local anesthesia (PSLA) for wrist arthroscopy without a tourniquet since 1998. The aim of the study was to assess the efficacy, safety, and complications of PSLA and whether this can be recommended for routine wrist arthroscopy.

Method 
We conducted a retrospective study, identifying 111 consecutive cases of wrist arthroscopies performed from January 2007 to December 2009. All cases were performed under PSLA. The effectiveness of PSLA was assessed by analyzing whether the procedure required adjuvant forms of anesthesia. The subjective effectiveness was assessed via phone questionnaires.

Results 
Sixty-eight male and 43 female patients were identified. The average age was 43.2 (range 16–77). The indications included chronic wrist pain of unknown origin (30), posttraumatic arthritis (27), rheumatoid arthritis (5), ganglion (30), triangular fibrocartilage complex (TFCC) injury (14), infectious (1), and carpal instability (4). The average duration of the procedures was 73 minutes (range 20–255 minutes). Therapeutic procedures were performed in all 111 cases in addition to a routine diagnostic assessment. These included arthroscopic debridement (82) synovectomy (6), ganglionectomy (30), TFCC repair (3), TFCC debridement (11), radial styloidectomy (2), wafer procedure (4), thermal shrinkage (2), distal scaphoidectomy (1), and synovial biopsy (4). All procedures could be completed uneventfully. Most patients tolerated the procedure well throughout the operation, and the satisfaction level was high. No complication was encountered.

Discussions 
We concluded that PSLA technique is a feasible mode of anesthesia in selected patients.

Level of evidence:
Level IV
All Author(s) ListMichael T. Y. Ong, P. C. Ho, Clara W. Y. Wong, Sally H. S. Cheng, Wing- Lim Tse
Journal nameJournal of Wrist Surgery
Year2012
Month11
Volume Number1
Issue Number2
PublisherThieme Medical Publishers
Place of PublicationUSA
Pages149 - 152
ISSN2163-3916
LanguagesEnglish-United Kingdom
Keywordswrist, arthroscopy, portal site, local anesthesia

Last updated on 2021-01-12 at 23:46