完全清醒（wide—awake）手外科手术的应用

The wide-awake hand surgery technique and its applications

目的介绍完全清醒手外科手术的方法，探讨其效果和应用范围。方法2012年10月至2013年4月施行完全清醒的手外科手术16例，11例行软组织操作，5例行骨操作。术前的注射疼痛，术中和术后的疼痛均使用视觉模拟评分法（VAS）评估，术中评估运动功能和术区出血情况，术后观察麻醉并发症和术区皮肤血供。结果完全清醒的手外科手术不影响运动功能，在不使用止血带的情况下可达到较好的止血效果。术前注射时仅有第一针的疼痛（VAS评分2～4），术中软组织操作无疼痛（VAS评分0），骨操作有一定的疼痛（VAS评分0～3）。术后均有较大变异的疼痛（VAS评分0～7）。术后均未出现术区皮肤的缺血坏死和麻醉并发症。结论完全清醒的手外科手术安全有效，有利于术中功能评估，性价比高，可广泛开展门诊手术。

Objective To introduce the wide-awake technique in hand surgery and to evaluate its effectiveness and clinical application. Methods Between October 2012 and April 2013, the wide-awake technique was applied in 16 hand surgery cases. The number of patients with surgery of the bone was 5 while the other 11 patients only had soft tissue operations. The visual analogue score （VAS） was used to evaluate preoperative injection pain, intraoperative and postoperative pain. The active movement and surgical field bleeding were evaluated during the operation. The anesthesia complications and blood supply of the skin in the surgical area were observed after the operation. Results The wide-awake technique in hand surgery did not restrict the active movement while achieving good haemostasis without tourniquet use. During the preoperative injections the patients only felt pain of the first poke （VAS 2 to 4）. There was no pain in soft tissue procedures （VAS 0）. There was light pain in procedures involving manipulation of bones （VAS 0 to 3）. The severity of postoperative pain varied （VAS 0 to 7 ）. No anesthetic complications and skin necrosis were noted postoperatively. Conclusion The wide-awake technique is safe and effective. It allows intraoperative monitoring of motor function. It is cost effective and can be carried out in outpatient settings.