الفهرس 
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Abstract
Flexor tendon injuries of the hand are challenging problem for surgeons due to three main reasons. Firstly, such injuries cannot heal without surgical treatment. Secondly postoperative management needs to be carefully planned as mobilization has shown to be essential to prevent adhesions and improve gliding but this carries the risk of rupture. Lastly due to the unique anatomy of the tendons running through flexor tendon sheathes, surgeons have to avoid increasing the bulkiness of the tendon through its sheath, as this may affect the functional outcome of the tendon.
An emerging technique in hand surgery is a ‘wide-awake’ approach, in which a conscious patient is undergone operation on under local anaesthesia. The bloodless field is achieved without a tourniquet by the vasoconstrictive effect of adrenaline (epinephrine) that is injected with the local anaesthetic. Adrenaline in fingers is safe and the myth that it causes finger necrosis has been thoroughly debunked through a multi-centre prospective study of over 3000 patients undergoing injections into fingers with adrenaline. Avoidance of tourniquet use, this protects from potential nerve damage and pain from limb ischemia in the awake patient.
WALANT overcomes the risks of GA, allowing the infirm and high-risk patient patients with diabetes, cardiac or renal diseases to undergo flexor tendon repair, overcoming the need for fasting, even temporary stop of medications and facilitating discharge at the same day. An awake patient allows the delivery of patient education throughout the surgery through dialogue with the operating surgeon. Costs could be reduced through reduced staff (no anaesthetist), reduces consumables and clinic requirements, as the patient has been fully educated throughout the procedure.
The aim of this study was to evaluate the wide-awake local anaesthesia without using of tourniquet in flexor tendon repair, emphasizing its hemostatic effect, intraoperative direct visualization and testing of strength repair and gliding through pulley system and hence discovery of gapping and rupture intraoperatively leading to reduction of postoperative re-rupture & adhesion and better range of motion.
The main results of the study revealed that:
The current study included 30 patients with 41 digits; 22 of them were males (73.3%) and 8 were females (26.7%). Their age ranged from 12 years to 58 years.
Using of epinephrine is safe and it is very helpful in reduction of blood loss and achieving a bloodless operative field also potentiates and prolongs the effect of local anaesthesia.
Using of sodium bicarbonate buffers the acidity of local anaesthesia and also prolongs its effect.
Post-operative pain was significantly lower when using WALANT especially during the 6 hours after surgery. pain response of patients, measured using the visual analogue scale (VAS) score, during injecting the wide-awake anesthesia had a median score of 2 with a range of 0-4 while during the operative procedure itself the median was zero meaning that the technique is nearly painless that is so hopeful guiding the surgeons to continue using it as it is satisfactory for both patients and surgeons. The VAS score 3hrs postop.13.3% of cases had no pain, 83.3% of cases had mild pain (score 1-4) and only 3.3% had moderate pain (score5-7) with median = 2 and IQR = (1.8-3). While 6hrs. postop. 53.3% of cases had mild pain (score 1-4) and 46.7% had moderate pain (score 5-7) with median = 4 and IQR = (4-5). No cases complained of severe pain.