Wide awake hand surgery
What is wide awake hand surgery?
Wide awake hand surgery is performed without sedation, general anaesthesia or a tourniquet. Local anaesthetic is gently injected directly into the affected part of the wrist, hand and/or fingers. The patient is completely alert during the surgery, and after the surgery he/she can sit up and go home.
Why have wide awake hand surgery?
Wide awake hand surgery has significant benefits for elderly patients and patients with multiple medical problems because it allows the avoidance of the risks, expenses and inconveniences of sedation and general anaesthesia. While modern anaesthesia is very safe it does have risks and complications - nausea, vomiting, sore throat, shivering, damage to teeth, damage to the eye, post operative chest infection, post operative confusion, serious allergy (anaphylaxis), nerve damage, death or brain damage.
What conditions can be treated with wide awake hand surgery?
Canadian surgeon Donald H Lalonde reported on 1400 cases of wide awake hand surgery at the 2008 conference of the American Society of Plastic Surgeons, and uses this technique on 95% of patients in his hand surgery practice. He has used this technique for carpal tunnel surgery, trigger finger release, hand fracture reduction, extensor tendon repair, flexor tendon repair, trapeziectomies, and tendon transfers and grafts. The same anaesthetic technique is commonly used for operations on the skin, including skin grafts and local flap reconstructions.
London surgeon Mr Quamar Bismil has founded the Worldwide Wide Awake Hand Surgery Group, of which Melbourne Hand Surgery is a member. He has published extensively in this field including wide awake hand surgery for 270 patients with Dupuytren's disease (fasciectomy), and a review of 1000 wide awake hand surgery cases including carpal tunnel, Dupuytren's contracture, trigger finger, trigger thumb, ganglions (simple and complex), mucoid cysts, lumps, ulnar nerve decompression, de Quervain's decompression and injections.
Is it comfortable?
A German study reported that 83% of patients who had this type of surgery would choose to undergo it again. A UK review of 1000 patients reports >99% satisfaction. In my experience it has a high patient satisfaction rate. The local anaesthetic injections are not painless - much as it is not painless to have a needle for an immunisation or to have blood taken - but I have found that with my gentle, slow injection technique all patients who are willing to try it have been able to tolerate it without difficulty. Most patients have skin lumps and bumps removed comfortably using local anaesthetic and this is very similar.
Can I have wide awake hand surgery?
Not all surgeries are suitable and not all patients and doctors are comfortable with this technique, but if you are interested be sure to ask your surgeon!