Introduction

Long-term hemodialysis patients experience many hand diseases caused by dialysis-related amyloidosis (DRA), with carpal tunnel syndrome (CTS) being the most common. For the patients with arteriovenous (AV) shunt, surgical decompression remains challenging because of the contraindications of a tourniquet. A technique called wide-awake local anesthesia with no tourniquet (WALANT), in which epinephrine provides hemostasis instead of the tourniquet, can be a good option for hemodialysis patients. The purpose of this study was to assess the prevalence of CTS and related factors in hemodialysis patients, and to establish the efficacy and safety of WALANT on hemodialysis patients with AV shunt.

Materials and methods

This prospective study included 275 hemodialysis patients between March 2013 and July 2019. 43 patients were diagnosed with CTS, involving surgical treatment on 70 wrists. We performed mini-open carpal tunnel release using WALANT on the AV shunt arm (defined as the WALANT group), while using lidocaine and a tourniquet on the arm without an AV shunt (defined as the tourniquet group). The operative time, surgical field bleeding (blood loss and hemostasis score), surgical pain (injection pain and tourniquet pain), outcomes, complications, and satisfaction were compared between the two groups.

Results

The incidence of CTS in hemodialysis patients was 15.6%. Longer dialysis durations were related to higher proportions of patients with CTS. There was no significant difference in blood loss (p = 0.184) and hemostasis score (p = 0.165) between the two groups. Clinical symptoms improved in all patients, and there were no severe complications. The WALANT group had a significantly longer preparation time of approximately 20 minutes, but they had low injection pain and no tourniquet pain. There was also no significant difference in terms of satisfaction levels (p = 0.212).

Discussion

CTS is a very common disease among hemodialysis patients. WALANT provided sufficient hemostasis without a tourniquet, despite the patients’ high bleeding tendency. The technique also had the advantages of low injection pain, no tourniquet pain, and no major complications. In this respect, WALANT can be a good choice for hemodialysis patients with AV shunt.

Level of evidence

II.

中文翻译：

---

无止血带全清醒局部麻醉下腕管松解术在血液透析动静脉分流患者中的应用

介绍

长期血液透析患者会经历许多由透析相关淀粉样变性（DRA）引起的手部疾病，其中腕管综合征（CTS）最为常见。对于动静脉 (AV) 分流患者，由于止血带的禁忌症，手术减压仍然具有挑战性。一种称为无止血带的全清醒局部麻醉(WALANT) 技术，其中肾上腺素代替止血带提供止血作用，对于血液透析患者来说是一个不错的选择。本研究的目的是评估血液透析患者 CTS 的患病率及相关因素，并确定 WALANT 对 AV 分流血液透析患者的疗效和安全性。

材料和方法

这项前瞻性研究包括 2013 年 3 月至 2019 年 7 月期间的 275 名血液透析患者。43 名患者被诊断为 CTS，涉及 70 个手腕的手术治疗。我们在 AV 分流臂（定义为 WALANT 组）上使用 WALANT 进行了迷你开放式腕管松解，同时在没有 AV 分流器的手臂上使用利多卡因和止血带（定义为止血带组）。比较两组手术时间、术野出血（失血量、止血评分）、手术疼痛（注射痛、止血带痛）、疗效、并发症及满意度。

结果

血液透析患者CTS的发生率为15.6%。较长的透析持续时间与较高比例的 CTS 患者有关。两组间失血量 ( p  =  0.184) 和止血评分 ( p  = 0.165) 无显着差异。 所有患者临床症状均有改善，无严重并发症。WALANT 组的准备时间明显更长，约为 20分钟，但他们的注射疼痛很轻，也没有止血带疼痛。在满意度方面也没有显着差异 ( p = 0.212)。   

讨论

CTS是血液透析患者中​​非常常见的疾病。尽管患者有高出血倾向，但 WALANT 无需止血带即可提供足够的止血效果。该技术还具有注射疼痛小、无止血带疼痛和无重大并发症等优点。在这方面，WALANT 可以成为具有 AV 分流的血液透析患者的良好选择。

证据等级

二。