Medical World Is Waking Up to Benefits of Wide-Awake Hand Surgery

Wide-awake local anesthesia no tourniquet (WALANT) hand surgery is one of the hottest topics in orthopedics today.

This surgical approach relies on a local anesthetic (such as lidocaine) to prevent pain and a hemostatic agent (such as epinephrine) to control bleeding without the discomfort of a tourniquet.

WALANT hand surgery is available at Lehigh Valley Health Network (LVHN)–Tilghman, one of LVHN’s hospitals dedicated solely to orthopedics, as well as other LVHN locations in the Lehigh Valley. Many common hand procedures can be performed this way, like:

• Trigger finger releases
• Tendon repairs
• Fracture fixation, in certain cases
• Carpal tunnel
• Cubital tunnel
• And many more

There are a host of benefits related to avoiding sedation, including a better perioperative experience and greater cost-effectiveness. Plus, individuals who might once have been considered “too sick” for surgery due to a comorbidity, such as heart disease or chronic obstructive pulmonary disease, can often undergo this type of procedure. Yet, many don’t realize that sedation-free surgery is an option.

“Even some physicians are not aware of the scope of what can be done with wide-awake surgery,” says hand surgeon Matthew Gonzalez, MD, who joined Lehigh Valley Orthopedic Institute in September.

In a WALANT procedure, the surgeon and patient can interact while still in the operating room. That can lead to better outcomes.

“With tendon repairs, for example, you can ask patients to flex and extend their fingers to see if there is any weakness in the repair or gaping of the tendons,” Dr. Gonzalez says. “If there is, you can address it on the spot or adjust the postoperative therapy regimen.”

Patient convenience is another major advantage. Preoperatively, individuals can eat a normal breakfast. Postoperatively, they typically leave the surgical center sooner than people who have the same surgery under sedation.

“Most can even drive themselves home,” says Paul Sibley, DO, Chief, Section of Hand Surgery, Lehigh Valley Orthopedic Institute. “I equate it with going to the dentist and having a tooth numbed up.”

Both surgeons use various techniques to manage patient anxiety during WALANT procedures. For example, individuals may listen to music of their choice or exchange small talk with a nurse while surgery is in progress. Dr. Sibley may also turn off the main room lights and play a light show that simulates a galaxy.

“It creates a cool environment, and I have the headlight on my loupes to see the surgery clearly,” Dr. Sibley says. “But if patients just want to close their eyes and concentrate to calm their mind, we certainly respect that, too.”