Patients’ perspective of wide-awake hand surgery — 100 consecutive cases

Abstract

The wide-awake hand surgery (WAHS) technique involves injecting lidocaine with adrenaline for hand surgical procedures that are done without the use of tourniquets, sedation, regional or general anaesthetic. This is a retrospective review of the first 100 consecutive patients who underwent operations using this technique at our centre. The operations included carpal and cubital tunnel decompression, trapeziectomy, tendon transfer, and tenolysis. A questionnaire adapted from Lalonde's previous work on wide-awake surgery was used to assess patients' experiences. Sixty-five percent of the patients responded to the postal questionnaire, the majority reporting a high satisfaction level. Ninety-one percent of responders reported that the operation was less painful or comparable with a procedure at the dentist; 86% would prefer to be wide-awake if they needed to have hand surgery again, and 90% stated they would recommend WAHS to a friend.

An Economic Analysis of MAC Versus WALANT: A Trigger Finger Release Surgery Case Study

“…Ninety-one percent of their patients felt the pain they experienced during surgery was comparable with a dental procedure and that anxiety levels were generally low. 11 Our study has some weaknesses. First, it is a retrospective study based on the experience of a single surgeon operating at a single institution.…”

Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet

“…Patients were given the opportunity to state their experiences immediately. Previous literatures investigated patient satisfaction, pain and anxiety level, retrospectively, 7,17 which could be inaccurate as perception may change over time. Our limitation in this study was that a single surgeon was involved in the surgery done and in administering injections.…”

Qualitative aspects of patient pain during surgery with wide-awake local anesthesia

“…For instance, studies focusing on hand procedures have found mean intraoperative pain ratings to be less than 1 out of 10. 15,16 Studies focusing on foot and ankle procedures have reported similar results. 5,6 Although ratings of pain intensity are useful, they are also unidimensional and ultimately provide a limited view of patient pain.…”

“…Past studies have found that anxiety during these surgeries is common, but it tends to decline steadily as the perioperative period progresses and patients become more comfortable with the surgical setting. 5,6,16,21…”