Wide-awake hand surgery

Many hand surgery procedures such as carpal tunnel release, tendon repair and removal of masses can now be performed under local anesthesia alone, avoiding the use of sedation or general anesthesia. The technique — known as wide-awake local anesthesia, no tourniquet (WALANT) — is sometimes performed in the surgeon's office.

The key is lidocaine with epinephrine: typically 0.5 to 1 percent lidocaine 1:100,000 or 1:200,000 with epinephrine. Epinephrine extends the action of local anesthesia and, as a vasoconstrictor, controls bleeding. For decades, dentists have safely used lidocaine with epinephrine to control bleeding during procedures. Although surgeons were long taught that the use of epinephrine with lidocaine was unsafe in the hand, multiple well-executed studies have disproved that myth.

The ability to safely control bleeding and extend the duration of local anesthesia allows hand surgeons to perform many procedures with minimal bleeding and without the use of sedation, general anesthesia or a painful tourniquet to control bleeding. WALANT also can be used safely in patients who have medical complications or take blood thinner medications — factors that might otherwise preclude surgery.

WALANT is used for:

• Trapeziectomy

• Dupuytren's contracture release

• Fracture fixation

• Ligament repair

• Osteotomy

• Joint replacements in the fingers

• Peripheral nerve procedures at the wrist and elbow

• Tendon and soft tissue procedures in the elbow, forearm, hand and wrist

Advantages for patients

Avoiding sedation or general anesthesia during hand surgery typically:

• Helps patients recover and return to normal activities more quickly

• Prevents the possible side effects and complications of sedation or general anesthesia, such as nausea

• Eliminates intravenous injections

• Eliminates the need for the patient to stop or "bridge" anticoagulant medications such as warfarin