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The Benefits of Wide Awake Hand Surgery

17 August 2015

Wide Awake Hand Surgery

Wide awake hand surgery is a method of performing surgery on the hand and wrist without sedation, without a tourniquet (a compressive blood restricting device) and without a general anaesthetic. This technique involves injecting local anaesthetic into the area of the hand and wrist that will undergo surgery. Many patients that undergo hand surgery are now suitable for this method.

Advantages for the Patient and Surgeon

There are many patient benefits of wide awake hand surgery which include no immediate post-operative pain, no post-operative grogginess or nausea and an earlier discharge from hospital than may occur with a general anaesthetic. This technique also enables a surgeon to deliver a truly patient centric hand surgery pathway as they can interact in real time with their patients during the operation.

Common Wide Awake Hand Surgery Procedures

Whilst carpal tunnel surgery and trigger finger releases are commonly performed under wide awake surgery there are now many more operations where the results are optimised by the patient being wide awake and include:

• Finger joint replacement – the implants can be inserted and tested for range of movement immediately on the operating table by asking the patient to move their own “new joint”.  If the joint is too stiff then more bone can be resected until the movement is perfected.

• Tendon repair and transfer – tendons that are repaired or transferred are assessed for correct tensioning and gliding immediately at the time of repair with the patient being asked to actively move their own hand. Any problems such as an over tightening or too slack repair can be identified and rectified.

• Release of catching structures – operations to remove catching tissues such as bone, tendons or ligaments can be performed with enhanced results, as the feedback is immediate and in real time.  For example, if after removing some offending bone the catching continues, the surgeon can take away a little more until the structures run free and the problem solved. Such “active” fine-tuning would not be possible with a patient under general anaesthetic unlike a wide-awake patient who is able to give dynamic feedback.

In many cases it is a bit like a wide awake ‘surgical test drive’ where a surgeon gets to see the results immediately and can micro adjust at the time optimising the results for their patient.

Mr Mike Hayton is a Consultant Hand and Wrist Surgeon at The Wilmslow Hospital,52 Alderley Road. For more information or to make an appointment with Mr Hayton please call 01625 545 036.

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