Background: 

The use of wide-awake, local-anesthetic, no-tourniquet (WALANT) surgical techniques is increasingly common, and patients commonly ask whether they may drive home following these procedures. The impact of a numb hand and bulky dressing on driving fitness is unknown, and there is no literature to guide surgeons when counseling these patients. Thus, the primary objective of the present study was to determine driving fitness following a modeled-WALANT procedure.

Methods: 

Twelve right-handed individuals (6 male and 6 female) with an average age of 50 years (range, 38 to 64 years) were enrolled. An instrumented vehicle was used to obtain driving kinematic and behavioral data, thus allowing for a multidimensional assessment of driving fitness. Participants first performed a drive to establish baseline kinematic metrics. The route included both public streets and a closed course. Several driving tasks were assessed, including reverse parking, parallel parking, and perpendicular parking. The total course length was 18 miles (29 kilometers) and took 45 to 55 minutes to complete. After the first drive, 10 mL of 1% lidocaine was injected in the volar aspect of the right wrist and another 10 mL was injected into the right carpal tunnel to model the anesthetic used for a WALANT carpal tunnel release, and a bulky soft dressing was applied. The modeled-WALANT drive included an identical route and tasks, in addition to a surprise event to evaluate emergency responsiveness. Driving metrics were analyzed for noninferiority of the modeled-WALANT state to baseline driving.

Results: 

The modeled-WALANT state showed noninferiority to baseline driving on all 11 analyzed dimensions of driving behavior compared with the control drives. In the modeled-WALANT state, participants drove more conservatively, braked harder, and steered more smoothly. All participants safely performed the 3 parking tasks and emergency response maneuver. Driving fitness in the modeled-WALANT state was noninferior to driving fitness in the preoperative drive.

Conclusions: 

A modeled-WALANT state has no clinically relevant negative impact on driving fitness, and thus surgeons should not discourage patients from driving home after unilateral WALANT surgical hand procedures.

Level of Evidence: 

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

---

建模的清醒，局部麻醉，无止痛的外科手术程序不会损害驾驶适应性：一项实验性道路非劣效性研究。

背景： 

使用清醒的局部麻醉无止血带（WALANT）外科手术技术越来越普遍，患者通常会问他们是否可以按照这些程序开车回家。麻木的手和笨重的敷料对驾驶健身的影响尚不清楚，并且在为这些患者提供咨询时，没有文献可以指导外科医生。因此，本研究的主要目的是确定遵循WALANT模型的驾驶适应性。

方法： 

登记了十二个右撇子个体（6名男性和6名女性），平均年龄为50岁（38至64岁）。使用仪表车辆获取驾驶运动学和行为数据，从而可以对驾驶适应性进行多维评估。参与者首先进行了建立运动学指标的运动。该路线包括公共街道和封闭路线。评估了多个驾驶任务，包括倒车，平行停车和垂直停车。总课程长度为18英里（29公里），需要45至55分钟才能完成。第一次开车后，在右手腕掌侧注入10 mL 1％利多卡因，再向右腕管注入10 mL，以模拟用于WALANT腕管释放的麻醉剂，然后铺上柔软的敷料。建模的WALANT驱动器除具有意外事件以评估紧急响应能力外，还包括相同的路线和任务。对驾驶指标进行了分析，以分析建模的WALANT状态与基准驾驶之间的差异。

结果： 

与控制驱动器相比，在所有11个分析的驾驶行为维度上，模型化的WALANT状态均显示出不劣于基线驾驶。在“建模-WALANT”状态下，参与者驾驶时更加保守，刹车更加猛烈，并且转向更加平稳。所有参与者安全地执行了3个停车任务和应急响应操作。在模型-WALANT状态下的驾驶适应性不亚于术前驾驶中的驾驶适应性。

结论： 

模型化的WALANT状态对驾驶适应性没有临床相关的负面影响，因此，外科医生不应在单方面进行WALANT外科手术后劝阻患者回家。

证据级别： 

治疗级别II。有关证据水平的完整说明，请参见《作者说明》。