With recent advances in our understanding of the activity and safety of local anesthetics with adrenaline in the hand, we are now able to perform hand surgeries with the patient wide awake. It is analogous to how dental or dermatologic procedures are often performed. Advantages of this technique for the patient include no pre-operative testing, no IV placement, no tourniquet pain, less time in the operating room, no sedation or anesthesia to recover from, the ability to drive oneself home alone, and the opportunity to speak with your surgeon during the surgery.
Wide awake hand surgery is still performed in an operating room either in a hospital or a surgical center. Prior to the surgery you will change into a gown. In the operating room, your hand is still prepared and cleaned. Prior to starting the procedure your hand surgeon will inject the surgical site with a small needle of a local anesthetic (ie, lidocaine or marcaine) mixed with epinephrine. This injection will numb the surgical site and also minimize bleeding thereby allowing your hand surgeon to operate on your hand while you are wide awake and without a tourniquet. After sutures are placed the hand will be dressed and you will be allowed to drive yourself home.
The bottom line is less cost, greater convenience, and less risk. Many of our hand surgeons have adopted wide awake hand surgery for the appropriate patient. Common surgeries that are being performed wide awake include carpal tunnel release, trigger finger release, deQuervain’s release, hand mass excisions, Dupuytren’s cord excisions, and tendon repair surgeries.
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