Wide Awake Hand Surgery

For a long time, hand surgery has been performed under general anesthesia. This means the patient is unconscious, or asleep. In health care, we have been trying to limit spending while at the same time providing added benefits and avoiding extra risks when possible; this includes moving away from general anesthesia when possible. I see this trend in my practice as a hand surgeon.

What is Wide Awake Hand Surgery?

Rather than being asleep for surgery, the patient will be wide awake during the surgery. We use the medications lidocaine and epinephrine so patients do not feel pain during surgery. In hand surgery, we refer to this as WALANT: Wide Awake Local Anesthesia with No Tourniquet.

Why might I want Wide Awake Hand Surgery?

The primary benefits of this type of surgery include:

  • Convenience: no fasting, no medication adjustments, no IV insertion, and less time getting pre-screened in the office, at your primary care provider’s office, or at the hospital for potential anesthesia issues
  • More independence: you can drive yourself to and from most surgeries and there is no need for someone to care for you overnight (which is required if you have any sort of general anesthesia)
  • Less cost overall: no anesthesia charge, no pre-operative lab work, no missed days of work pre-operatively to get evaluated by your primary care provider, etc
  • Avoidance of potential complications from general anesthesia such as nausea or urinary issues
  • We can talk about what’s going on during surgery, including minor adjustments or anatomy notes that could impact care down the line. We may test range of motion. You can even ask me questions!

Is Wide Awake Hand Surgery for me?

Wide awake surgery is appropriate for a wide variety of hand problems. It may not be suitable for large or more invasive procedures.

Other patients may not be able to handle wide awake hand surgery because they don’t want to experience the sounds of surgery. There are ways to mitigate these fears, but ultimately some patients may not be comfortable, and that is okay.

The reality is, wide awake hand surgery is simply another tool in the toolbox for a highly-trained hand surgeon that can provide the best service to you when seeking care for your hand problem. At OrthoNebraska, our hand surgeons discuss cases and best practices on a continual basis, which should give patients confidence that we are creating a thoughtful, customized care plan to anyone who sees us.

If you’re interested in learning more about wide awake hand surgery, please make an appointment with me by calling (402) 609-3000.

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