Ask a Doctor: Wide Awake Surgery

Ask a Doctor: Wide Awake Surgery
What is wide awake surgery?
Wide awake surgery is a surgery performed with the patient completely awake using only local anesthesia. Normally, surgery is performed using general anesthesia in which the patient is asleep.  General anesthesia is not necessary for many surgeries and can be risky in some cases. Wide awake surgery is a technique that avoids this problem and can be performed in an operating room or in the office. It is commonly used for problems of the hand and wrist.
How does it work?
Wide awake surgery is performed only with local anesthesia. This uses medication (such as lidocaine or marcaine) that is injected underneath the skin in order to cause numbness and prevent pain in a specific area of the body. This medication is commonly used in dental procedures and usually is not painful when injected. Some other medications may be added to prevent bleeding (such as epinephrine) or to minimize pain (such as bicarbonate) when the anesthesia is injected. After a short wait, the hand is cleaned with antibiotic soap to prevent infection, and the surgery can be done safely with no pain to the patient.  You will be able to move other parts of your body, parts that were not injected with medication, freely.
The surgery can be performed with a tourniquet to prevent bleeding, but in many cases a tourniquet is not needed. When a tourniquet is not used, this is referred to as WALANT (Wide Awake Local Anesthesia, No Tourniquet). This can help make the procedure more comfortable.
The numbing effect lasts a minimum of one hour and sometimes for several hours to help with pain once the patient is home.  Patients may drive to and from surgery on their own, and they can resume their activities of daily living immediately after surgery while taking normal precautions.
What surgeries can be performed?
Wide awake surgery can be performed for a variety of conditions and is based on the preference of the surgeon and the patient. It is most commonly performed for tendinitis of the hand and wrist (such as with trigger finger surgery and De Quervain’s tenosynovitis), cysts on the finger, masses or tumors of the hand and wrist, carpal tunnel syndrome, and Dupuytren’s contractures. These surgeries usually last under 15 minutes.
In many cases, it can also be used for more complicated procedures. These include tendon or nerve repair, treatment of broken bones/ fractures, ligament repairs, surgery for arthritis (such as joint fusion or joint replacement), infections, and amputations.
Why wide awake surgery?
Patients may prefer wide awake surgery for several reasons. First, it is easy to coordinate and can be done without obtaining extra tests (such as lab work). In many cases it can also be done in the office setting without the patient having to change their clothes. This makes the procedure more cost-effective for the patient and the surgeon. Second, the surgery is convenient, as the patient can drive to and from the procedure without a ride.  Third, the procedure is a much safer and simpler option when compared to general anesthesia. Lastly, the procedure often can be very educational and informative for the patient. In many cases, having patients participate in the surgery with actively moving their fingers when instructed can help ensure that the surgery is done well.
Some patients prefer to be asleep for surgery and do not want to be awake. This is reasonable and can be discussed with the surgeon.
Wide awake surgery for the hand and wrist is an excellent treatment option that can be beneficial for both the patient and the surgeon. Please talk to your hand surgeon about the best treatment option for you.

 Amar A. Patel, MD is board-certified orthopaedic surgeon who focuses on conditions of the hand, wrist, and elbow. He completed his orthopaedic residency at the University of Miami and his hand surgery fellowship at the Indiana Hand to Shoulder Center. He currently works at South County Orthopaedic Specialists in Laguna Woods, California where he utilizes wide awake surgery for nearly half of his surgeries.
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