Wide Awake Surgery


What is Wide Awake Surgery?

For a long time surgery involved sedation or general anesthesia, inducing a loss of consciousness in order to keep a patient comfortable. Although this works well and is often necessary for larger surgeries, the medications used to induce sleep can have unwanted side-effects such as nausea, confusion, and memory loss.

Thanks to some innovative hand surgeons, new techniques have been developed that allow for procedures to be performed with no sedation or general anesthesia. This is done by injecting a local anesthetic (lidocaine) which numbs the part of the hand or arm where the surgery will be performed. The injection often includes a medication that temporarily constricts the blood vessels in the area where the surgery is being performed (epinephrine).

This allows the surgery to be performed with the patient awake, but without feeling pain from the procedure or tourniquet. Tourniquets (tight blood pressure cuffs) are often used to squeeze the arm during surgery and temporarily constrict blood flow. Although this is safe and effective, it can be painful. The practice of using lidocaine with epinephrine to allow

or pain free surgery with the patient awake is called WALANT. That stands for Wide Awake Local Anesthesia No Tourniquet.

Dr. Abrams utilizes this innovative technique to treat many different conditions and injuries in the hand and wrist. This is done in a procedure room in an outpatient setting. All of the standard surgical precautions are still observed with an emphasis on patient safety and sterility. Allowing patients to stay awake means they spend less time at the facility and often don’t even require an IV. This means that the recovery begins as soon as the bandage is applied.

What procedures can be performed using Wide Awake Surgery (WALANT) techniques?

  • Carpal Tunnel Release
  • Trigger Finger Release
  • Cyst/mass excision
  • Tendon Repair
  • Small joint fusions in fingers
  • 1st dorsal compartment (DeQuervain’s release)

What are the benefits of Wide Awake Surgery (WALANT)?

  1. Decreased cost - patients do not have the cost of sedation or general anesthesia
  2. Fewer side-effects - there are none of the typical side-effects from sedation or general anesthesia (nausea, confusion, memory loss)
  3. Quicker recovery time - there is no grogginess after surgery and the patient can begin post-operative exercises immediately
  4. Sooner return to normal activities - the lack of sedation allows patients to take an active role in their recovery and return to their normal routines faster
  5. Less pain - although patients feel the initial injection of medication, not using a tourniquet and staying alert throughout the procedure prevents the post-operative pain from the tourniquet and sudden/confused feeling of waking up and feeling pain
  6. Shorter wait times - because these surgeries are performed in a procedure room with the patient awake they can often be scheduled quicker than surgeries in an operating room that require the aid of an anesthesiologist
  7. Safer for the environment - this technique generates less medical waste and occupies fewer resources than traditional surgery for the same condition

Am I a candidate for Wide Awake Surgery (WALANT)?

Dr. Abrams will discuss this technique as well the risks and benefits of wide awake surgery versus traditional sedation/anesthesia at the pre-operative visit. The decision to go forward with surgery with the patient awake often has to do with the patient’s preference and recovery goals in addition other health related factors. These will be evaluated and discussed at the time of the patient’s pre-operative visit.

What can I expect during my procedure?

Dr. Abrams performs Wide Awake Surgeries in an outpatient setting at Pardee Hospital. The patient checks in at the day surgery desk and is then taken back to a private room to prepare for the procedure. There, patients are met by a nurse who is experienced in getting patients ready for Wide Awake Surgeries. The patient’s arm is cleaned and the injection is prepared. Dr. Abrams then visits with the patient to answer any questions about the surgery or recovery. Once the patient is ready the operative site is injected to make it numb. The medication is given some time to begin to work and then the patient walks with a nurse back to the procedure room.

In the procedure room the arm is cleaned again and operative drapes are applied to the arm to keep the surgical field sterile. The patient picks the music during the surgery and is able to chat with a friendly nurse at the bedside. They are also able to ask Dr. Abrams questions or talk about what is going on during the surgery.

After surgery Dr. Abrams talks with the patient about everything that was done during surgery and what to expect from the recovery. The patient then goes to the recovery area where they are provided a private room, given a drink and small snack. The recovery nurse then provides the patient with written post-operative instructions and goes over them step-by-step. The patient then heads home and begins their recovery.

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