High Five! Wide-Awake Hand Surgery Offers New Options

By Nathan Bodin, MD, Hand Surgeon — Virtua Hand Surgery and Rehabilitation Center

From writing to cooking to tying our shoes, we use our wrists and hands for everything. So if they hurt, our ability to function takes a significant hit.

In many cases, rest, medication, braces, and physical therapy will help relieve your pain. For injuries that do require surgery, an innovative approach performed without general anesthesia can speed your return to everyday activities.

The technique, known as wide-awake local anesthesia, no tourniquet (WALANT), may be done in the surgeon’s office, and in the same time as a normal appointment.

Patients are comfortable during the procedure without experiencing the side effects of full sedation. As you are wide awake, you can participate in the surgery, allowing the surgeon to check the integrity of the repair and make any necessary adjustments.

Learned from Dentistry
If you’ve ever had dental surgery, you’ve probably had a form of WALANT. Lidocaine numbs the area to be treated. Epinephrine extends the duration of the lidocaine and controls bleeding, so a tourniquet often isn’t necessary.

Conditions commonly treated with wide-awake surgery include:

• Trigger finger
• Tendon and ligament repairs
• Removal of masses and small tumors
• Contractures, abnormal thickening of the skin in the palm usually affecting the ring and little fingers

Advantages of WALANT
WALANT has many benefits compared to conventional procedures. People whose medical conditions would otherwise make them high risk for surgery are eligible for treatment. Preoperative blood work and fasting are not required, and patients may not need to stop their blood thinners.

Additional advantages include:

• Convenience. As there is no recovery from general anesthesia, you can drive yourself to the office and return to daily activities later in the day.
• Less postoperative pain. Often, only pain relievers like Tylenol or Motrin are needed.
• Lower costs.
• Quicker recovery and less need for physical therapy.

Unlike some conventional procedures where we would have to wait for you to recover from general anesthesia to check the efficacy of the repair, we can do it while we are still in the procedure room. For example, after connecting two pieces of tendon, you can show the surgical team that you can fully move it. Or, if the surgical team is treating a trigger finger, that you can make a fist. We know right away that we are providing you the optimal treatment, reducing the need for additional surgeries.

We’re pleased to offer this approach to South Jersey.

Expert Care for Your Hardworking Hands
Virtua’s fellowship-trained hand surgeons provide the latest treatments to get you back to work and play without hand and wrist pain. Request a consultation today.  

Updated January 14, 2022