One of the most significant advances in hand and wrist surgery has been the advent of wide-awake surgery.
Wide-awake surgery allows patients to be completely awake during surgery by using only local anesthesia and eliminating the need for sedation or a general anesthetic. While it may sound gruesome to be fully conscious when you go under a surgeon’s knife, the benefits to patients are many. This technique improves surgical outcomes and the patient experience because it eliminates the need for traditional pre-operative testing, and fasting on the day of surgery. Patients are able to stay alert and interact with their surgeon about the procedure and post-operative plan without the residual grogginess associated with sedation.
What is Wide-Awake Surgery?
In the past, patients undergoing hand and wrist surgery would have a tourniquet applied around the upper arm and inflated during surgery to keep blood out of the surgical area. In most cases, patients would require sedation or general anesthesia to tolerate the pain caused by the tourniquet. In wide-awake surgery, the only medication administered to the patient is a local anesthetic mixed with epinephrine that is injected in the surgical site. The way it is injected, in combination with the epinephrine, allows for a bloodless operative field. This eliminates the need for a painful tourniquet and the sedation needed to endure the discomfort.
The Benefits of Wide-Awake Surgery
The most significant benefit of wide-awake surgery is its ability to improve surgical outcomes. This is because certain procedures such as trigger finger release and tendon repairs, can be tested during surgery with an awake, comfortable patient using voluntary, active motion. Typically, a patient would need to be awakened to groggily perform the tests and then re-sedated during surgery, or the patient would remain sedated and the surgeon would test the success of the procedure using passive motion, which can produce inferior results.
Wide-awake surgery also requires fewer pre-operative demands on the patient, as there is no need for the battery of pre-operative tests such as blood work, chest x-rays or EKGs, that is usually required before surgery. This saves the patient time, anxiety, discomfort, and expense.
Nor do patients need to fast prior to a wide-awake procedure. This is particularly significant for patients with certain medical conditions, such as diabetes, where blood sugar control can be challenging. Since patients can eat and drink up to the time of surgery, there is no disruption to regular medicines taken, or concern about drug interactions with anesthesia.
Wide-awake surgery benefits the patient further because they are clear-headed to discuss the surgery, the post-operative plan and expected course of recovery with their doctor during or immediately following the procedure.