Wide-Awake Hand Surgery in Austin, TX — Dr. Benjamin Amis | ATX Orthopedics
At ATX Orthopedics in Austin, Texas, Dr. Benjamin Amis, MD specializes in wide-awake hand surgery — a technique that allows most hand procedures to be performed comfortably under local anesthesia, without general anesthesia, sedation, or a tourniquet.
As recently featured on the front page of the New York Times, there is a growing trend in hand surgery to perform some procedures with a newer technique of anesthesia called wide-awake hand surgery. Traditionally, hand surgery has been performed under general anesthesia or sedation. A tourniquet is used during the surgery to help control bleeding and a local anesthetic would be applied at the end of the surgery for pain control.
During wide-awake hand surgery, a local anesthetic is applied to the surgical site approximately twenty minutes prior to the beginning of the procedure. The injection consists of lidocaine, a numbing agent, and epinephrine, a vasoconstrictor which controls bleeding. Epinephrine’s ability to control bleeding is very important because this allows the surgery to be performed without a tourniquet which may be a source of discomfort during surgery. About twenty minutes after the injection, the surgical site and surrounding area will be completely numb with minimal bleeding, allowing the surgery to be performed with the patient wide-awake. The patient my feel some pressure or movement in the area, but no pain.
Wide-awake hand surgery is not recommended for all procedures or every patient. The patient must be able to handle the stress of the operating room and to keep the operative hand still. I commonly perform trigger finger releases using the wide-awake technique but it is also available for numerous other procedures. Many patients prefer the wide-awake surgery for a variety of reasons such being able to drive themselves to and from the surgery center, not having to undergo general anesthesia or sedation, and the faster immediate post-op recovery time. Many patients also prefer to be asleep for surgery and that is completly fine as well. The decision for which type of anesthesia to use is made with each patient on an individual basis. I want each patient to be 100% comfortable during their surgery experience, which helps the surgeon to be comfortable, and results in a better overall experience and outcome for everyone.
Schedule a Consultation with Dr. Amis in Austin, TX
Interested in learning whether wide-awake hand surgery is right for your procedure? Dr. Amis will discuss your options at your consultation appointment. Most hand surgeries are performed at Pinnacle Surgery Center of Austin as an outpatient procedure. Book your appointment online or call (512) 960-4590.
What Procedures Can Be Performed with Wide-Awake Hand Surgery?
Wide-awake local anesthesia with no tourniquet (WALANT) is suitable for a wide range of hand and wrist procedures. Common operations performed with this technique include trigger finger release, carpal tunnel release, de Quervain’s tenosynovitis release, ganglion cyst excision, tendon repair, tendon transfer, Dupuytren’s fasciectomy, and a variety of fracture fixation procedures. The key requirement is that the operative area can be adequately anesthetized with local infiltration of lidocaine and epinephrine. For more complex reconstructive procedures or cases requiring extensive dissection, traditional anesthesia may still be preferred.
Benefits of Wide-Awake Hand Surgery for Patients
Wide-awake surgery offers a number of meaningful advantages over traditional operating room surgery under general anesthesia or sedation. Patients avoid the risks and side effects of general anesthesia, including nausea, prolonged grogginess, and the rare but serious complications associated with airway management. Because no tourniquet is used, patients do not experience the aching discomfort that can accompany prolonged tourniquet inflation, and surgeons benefit from better visibility of blood flow and tissue perfusion during the procedure. Recovery is typically faster — most patients can eat and drink normally immediately after surgery and many are able to drive themselves home. The wide-awake approach also allows for real-time assessment of tendon function and repair quality during the procedure, which is a meaningful advantage for tendon surgery in particular.
Is Wide-Awake Surgery Right for You?
Most healthy patients undergoing elective hand and wrist procedures are candidates for the wide-awake approach. Patients with anxiety about injections or who feel strongly that they do not want to be awake during surgery may prefer sedation or general anesthesia — and that preference is always respected. Dr. Amis will discuss your options at your consultation and help you determine the anesthesia approach that best suits your procedure, health history, and personal preferences. To schedule a consultation for hand or wrist surgery in Austin, TX, contact ATX Orthopedics at 512-960-4590.
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Written by
Orthopedic Surgeon | Shoulder & Hand Specialist
Dr. Benjamin Amis is a fellowship-trained orthopedic surgeon specializing in shoulder surgery, rotator cuff repair, shoulder replacement, and hand & wrist conditions. He sees patients at ATX Orthopedics in Austin, TX. View full bio →
