Wide Awake During Surgery...

Dr. Donald LaLonde from New Brunswick, Canada has really paved the way for the way we do most minor hand surgeries today.  When I first started doing carpal tunnel and trigger finger releases 10 years ago, I did things very differently than I do now.  Back then, I would bring all of my patients to the operating room and have them sedated, and in some cases under general anesthesia. It did strike me as a bit wasteful and inconvenient for the patient to be treated with all the same drapes as if we were doing a major surgery.

Dr. LaLonde showed that it is safe to use lidocaine with epinephrine in hands and fingers.  He calls this technique WALANT or Wide Awake Local Anesthesia No Tourniquet.  Patients are more comfortable during surgery because the epinephrine reduces any bleeding, obviating the need for a tourniquet.  As a result, many surgeons here in the US have started doing these surgeries in the office, rather than the operating room.  This has dramatically reduced waste, cost, and patient inconvenience.   We still use sterile drapes, but just over the hand and arm.  Because they are awake, I am able to talk to my patients and explain their surgery and postop instructions.  

In my practice, I now routinely perform the following surgeries under local anesthesia:  

• Trigger finger releases
• deQuervain's tenosynoviits
• Cyst and mass removals
• Open carpal tunnel releases

I have had a couple patients request that they have surgery in the operating room because the thought of being awake made them nervous.  However, the vast majority of patients have been very satisfied with the office based procedure.  They like the fact that they don't have to be NPO (fasting) before surgery.  Although there is the brief discomfort associated with numbing the hand, there is no need for an IV in the arm.  Likewise, there's no post anesthesia grogginess or nausea.  Although it's always best to have a ride home, some patients even drive themselves to and from the office.  Most patients spend an hour or less in the office which is a huge improvement compared to the operating room.

About Roger C. Sohn, MD