The wide awake approach to hand surgery means hand surgery with surgeon administered pure locally injected anesthesia (lidocaine + epinephrine) in the hand and fingers of totally unsedated patients without a tourniquet. When this is done as will be shown in the course, all the patient feels is the first poke of the first 27 gauge needle.
Patients quickly become accepting of this technique as it makes hand surgery much more convenient for them. They do not have to have a separate preoperative anesthetic visit and they go home after surgery without nausea and vomiting, just like when they go to the dentist. They never have to be admitted because of anesthetic issues. The pain of the local anesthetic is no more painful than the starting of an intravenous (which is not necessary in wide awake hand surgery).
The surgeon is able to do many more cases in the same amount of time as there is no anesthesiology time. The surgeon is able to anesthetize patients himself between cases while the nurse(s) turn over the room.
The pain-free, unsedated patient is able to actively move reconstructed structures in an environment which allows the surgeon to make repair adjustments before closing the skin. In tendon transfers such as EI to EPL, one of the most difficult things to do is to get the tension just right. When the patient is wide awake, comfortable and cooperative, he can actively move the thumb with the transferred tendon in the operating room to test full flexion and extension, and the surgeon can make the transfer tension tighter or looser before the skin is closed.
In flexor tendon repair, the comfortable unsedated patient actively fully flexes the freshly repaired flexor tendon before the skin is closed. If the surgeon sees a gap form because the suture bunches in the tendon with active movement, the gap can be repaired. If the tendon repair does not fit through the pulleys, the repair can be adjusted or pulleys divided to ensure full movement before closing the skin. Rupture and tenolysis rates are improved.
The surgeon gets uninterrupted time during the surgery to get to know his patient and teach him post operative care. The combination of intraoperative active movement which allows for adjustments and the richness of the intraoperative communication with the patient lends a whole new dimension and enjoyment to hand surgery.
Learning Objectives: - This course will provide the necessary information to allow the hand surgeon to perform most common hand operations (95% of adult hand operations) such as carpal tunnel release, trigger finger release, trapeziectomy, flexor tendon repair, operative reduction of finger and hand fractures, palmar fasciectomy, finger fusion, tendon transfers, cubital tunnel release/tranposition etc. using the wide awake approach to hand surgery.
- A detailed explanation of how the surgeon easily and efficiently administers the local anesthesia between cases for most hand operations will be provided and illustrated with drawings and film.
- The benefits to the patient which include no preoperative anesthetic assessment visit, no nausea and vomiting, no admissions postoperatively due to anesthetic effects etc. will be outlined. These patients get up and go home like they have been to the dentist.
- The myths and safety issues of epinephrine in the finger will be addressed
- The surgeons will be able to delete the costs and inconveniences of an anesthesia provider in most of his hand practice as the surgeon becomes the sole anesthesia provider in a safe, efficient manner, and do more surgery in the same amount of time as there is no waiting for the anesthesiologist. This is particularly true in carpal tunnel and trigger finger surgery.
http://www.assh.org/AnnualMeeting/program/Pages/Instructional-Course-Lectures.aspx
