Unsedated Hand Surgery

I wanted to share some of the things we are doing here in the clinic that I felt like was routine but certainly does not appear to be so here in Austin, Texas. Wide awake hand surgery, or hand surgery performed under local anesthesia alone, has been popularized by Dr. Lalonde and others and allows many routine hand surgeries to be performed without general or intravenous sedation anesthesia. Why is this important? Well without using a intravenous or general anesthetic your risks of having a negative outcome have just dropped to almost zero. There is no risk of airway problems, stroke, heart attack, or blood clots. While this happening with general or intravenous sedation are rare they can certainly increase in older patients or those with co morbidities such as hypertension, diabetes, or COPD.

What can I expect with a wide awake hand surgery? The procedure is performed in our office procedure room using the same sterile technique as we use in a hospital or surgery center. The difference is a smaller surgical field using sterile towels rather than an entire drape package to cover your entire body. The area of interest is then injected with a dilute solution of xylocaine and epinephrine very slowly so that the typical patient only feels the fine needle at the start of the procedure. The amount injected is much more than we typically would use for a hand surgery case performed at the hospital but well under any amounts typically used for say liposuction. We then wait, and then wait some more. Sometimes up to 20 minutes to allow the epinephrine to maximally constrict the blood vessels in the area. During this time you can continue to read a book, check your phone or have a restroom break. I have a great headlight and my 4x surgical loupes at my disposal in the office so we have the same tools needed to perform in office versus hospital setting. After the procedure is completed typically a soft bandage or splint is applied and depending on the procedure performed might be able to drive yourself home. You certainly can get up out of the procedure chair and walk out of the office. No feeling groggy waking up from a general anesthesia nor the nausea that can frequently accompany a general anesthetic.

So what procedure's can I perform with wide awake hand surgery? Well carpal tunnel, cubital tunnel release, Guyon's canal release, Duputyren's contracture, Trigger finger release, ganglion cyst removal, removal of soft tissue tumors, some tendon injuries, and the list keeps expanding.

What has become increasingly more important to look at with procedures is the true cost of the procedures as our insurance coverage in fact decreases with higher and higher deductibles. For example a typical carpal tunnel release performed with participating providers on your insurance would cost a surgeon fee, anesthesia fee, and facility fee. This depending on the contract rates could be an the range of a 2-3 thousand dollars and if you have a high deductible plan you may be paying all of that. With wide awake hand surgery in our office you will just receive the one surgeon's fee. No anesthesia fee and no facility fee. So usually this is sometime one third or half of what it would cost in the surgery center. This is also assuming the facility and anesthesia providers are in network with your plan which is becoming more likely that they are not going forward. We participate with the vast majority of insurance carriers in our area as well as Medicare. For patients without insurance we are happy to give you and up front price that can be quite affordable. Not only will your hand surgery cost less with us but it will be safer for your avoiding a general anesthetic or sedation.

Stay tuned for more information and videos of the procedures and please share with your friends.