Wide-Awake Anesthesia in the In-Office Procedure Room: Lessons Learned

Overview

Journal Hand (N Y)

Publisher Sage Publications

Specialties General Surgery
Orthopedics

Date 2017 Jun 25

PMID 28645218

Citations 26

Authors

Robert E Van Demark Jr

Hillary A Becker

Matthew C Anderson

Vanessa J S Smith

Affiliations

Soon will be listed here.

Abstract

Background: Wide-awake local anesthesia and no tourniquet (WALANT) has become more popular in hand surgery. Without a tourniquet, there is no need for preoperative testing or sedation. The use of lidocaine with epinephrine has allowed a larger variety of cases to be done safely in an outpatient setting instead of the hospital. "Minor field sterility," which uses fewer drapes and tools to accomplish the same procedures, is a concept that is also gaining recognition.

Methods: Investigation of hand surgeons performing a majority of cases using WALANT and minor field sterility was the beginning of seeing its potential at our institution. Administration was concerned about patient safety, cost-effectiveness, and patient satisfaction of the proposed changes. Analysis of our institution to determine location of these procedures was also imperative to using WALANT.

Results: An in-office procedure room was built to allow for WALANT and minor field sterility. The requirements and logistics of developing an in-office procedure room for wide-awake surgery are reviewed in this article.

Conclusions: The concurrent use of WALANT and minor field sterility has created a hand surgery practice that is cost-effective for the patient and the facility and resulted in excellent patient outcomes and satisfaction.

Citing Articles

Guidance for delivering surgical procedures outside operating theatres: scoping review.

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Main Operating Room Versus Field Sterility in Hand Surgery: A Review of the Evidence.

Silver N, Lalonde D Plast Surg (Oakv). 2024; 32(4):627-637.

PMID: 39439664 PMC: 11492193. DOI: 10.1177/22925503231161073.

Assessing Public-Reported Perceptions of Low-Risk Hand Surgery Provided in the Office Versus an Ambulatory Surgery Center: Survey Study.

Tooley T, Feng J, Mouzaihem H, Khan J, Bohr M, Rohde R J Hand Surg Glob Online. 2024; 6(5):619-626.

PMID: 39381379 PMC: 11456624. DOI: 10.1016/j.jhsg.2024.05.001.

Safety and Efficacy of In-Office Hand Procedures.

Knopp B, Esmaeili E J Hand Microsurg. 2024; 16(2):100037.

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Gianakos A, Kennedy J J Am Acad Orthop Surg Glob Res Rev. 2024; 8(2).

PMID: 38385718 PMC: 10883628. DOI: 10.5435/JAAOSGlobal-D-23-00124.

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