Patients with hand injuries are being offered the opportunity to take part in a trial that will look at whether a general or localised anaesthetic is preferable during surgery to repair the tendons.   

The trial, which is being led by clinicians at the Royal Free London, is aimed at patients who have injured their flexor tendons, which commonly happens following a cut to the hand such as during food preparation or DIY. The flexor tendons allow the fingers to bend and the hand to make a fist and, following an injury if they are not surgically repaired, it can cause loss of function in the fingers.  

The Royal Free Hospital receives referrals for hand injuries from across north London seeing approximately 5,000 patients each year.

The multicentre (WAFER) clinical trial, which is being funded by the National Institute for Health and Care Research, is aiming to recruit 60 patients who will be placed on one of two treatment pathways. On one path patients will receive the current method of care where they are treated under general anaesthetic or by blocking the nerve supply to the entire arm to make it numb - also known as regional anaesthesia. During both these procedures, a tourniquet is used to reduce or stop blood flow in the arm so the surgeon has a clear vision of the cut ends of the tendon.

On the second treatment path patients will receive an injection to numb the hand which contains adrenaline to control bleeding, enabling the surgery to be performed while the patient is fully awake, without using a tourniquet. This enables the surgeons to check the quality of the repair by asking the patient to move their fingers and make any adjustments to the repair during surgery.

The study is being led by consultant plastic surgeons Mr Dariush Nikkhah and Professor Ash Mosahebi, with support from plastic surgery trainees led by Mr Muholan Kanapathy, the hand therapy team, the anaesthetic team and the clinical trials unit at UCL. Teams from Manchester University NHS Foundation Trust and Leeds Teaching Hospital are also taking part.

Professor Ash Mosahebi said: “This is an important trial to look at reducing the need for more invasive anaesthetic techniques in hand surgery.”

Mr Dariush Nikkhah said: “This trial aims not only to provide high quality evidence to improve clinical outcomes, it could also result in savings for the NHS due to reduced recovery time from anaesthesia and improved efficiency.”

Ms Nikki Burr, consultant hand therapist, added: “This trial could help us further improve the patient’s experience following their surgery and improve overall outcomes.”

Mr Muholan Kanapathy, a plastic surgery registrar, said: “This trial is a good opportunity for trainees to contribute to high quality research that can make a difference to the future care of patients.”

Find out more here.