Surgery has seen a dramatic technological advancement over the last decade. In some fields of medicine this happens slowly and in others the pace is breakneck. In hand surgery the old dogma of not using lidocaine with epinephrine in the hands for fear of ischemia has gone by the wayside, opening up a whole new frontier of treatment options. WALANT, or Wide Awake Local Anesthesia No Tourniquet surgery, is the latest advancement in the field of hand surgery. In the past, when performing certain types of surgery such as tendon repairs, a surgeon would have to rely on direct visualization and personal experience to accomplish the task. Today, the patient is able to participate in their own care by actively demonstrating the integrity of a repair during surgery by moving their fingers. This ability is nothing short of amazing. By allowing the patient to engage the repaired tendons in the operating room and demonstrate the function of those tendons, rather than waiting to see how things turned out later in the office, the guesswork is removed, ultimately leading to better outcome.
While one might think that most people would not want to be aware of anything going on in the operating room, they would be surprised by how many people want to be awake, or even want to watch, their surgery. And for those people afraid of anesthesia or at high risk for anesthesia complications, this option is a godsend. This may seem scary to many; however, in reality a patient can participate in any way they are comfortable, often helping their surgeon to help them. Whether it is by watching the procedure, speaking with the surgeon for reassurance or passively laying on the other side of the surgical drapes, the patient can take comfort in the knowledge that their surgeon is an expert in his field and is providing them with the best care possible. Whatever the patient chooses, there is no pain involved.
One of the distinct advantages of WALANT surgery is that because there is no general anesthesia or sedation involved, the patient is completely recovered by the time the procedure is over. By avoiding anesthesia and the inherent risks associated with it, a patient can go home feeling like themselves immediately after surgery, and will not have to sit in the recovery room impatiently waiting to get home.
Tendon repair is just one example. This technique can be used in many areas of hand surgery. Whether for carpal tunnel surgery, trigger finger surgery or even certain fractures, this technique allows both the surgeon and the patient to be comfortable that they have provided and received, respectively, the best care possible.
This kind of surgery not experimental or part of a medical trial; however, it is cutting edge. There are very few hand surgeons that are able to perform this kind of surgery and it is not for everyone. However, for many patients, this kind of surgery can help them achieve a better outcome while at the same time avoiding any risks associated with anesthesia, and can often provide them with a better overall surgical experience.
By Michael Horowitz, MD, FACS
Dr. Michael Horowitz is a hand surgeon at The Center for Musculoskeletal Disorders in Englewood and Manhattan. In addition to minimally invasive surgery, Dr. Horowitz offers WALANT as an option to his patients to further provide them with the latest treatment options and the best care possible.
