Many hand surgery procedures such as carpal tunnel release, tendon repair and removal of masses can now be performed under local anesthesia alone, avoiding the use of sedation or general anesthesia. The technique—known as Wide-Awake Local Anesthesia, No Tourniquet (WALANT)—can be performed in the surgeon’s office. The ability to safely control bleeding and extend the duration of local anesthesia allows hand surgeons to perform many procedures with minimal bleeding and without the use of sedation, general anesthesia or a painful tourniquet to control bleeding. WALANT also can be used safely in patients who have medical complications or take blood thinner medications—factors that might otherwise preclude surgery. While WALANT can be performed in an Ambulatory Surgery Center, it is often performed in the office and therefore considered an Office-Based-Surgery (OBS).
The issue is that there are numerous procedures that are considered “facility-only” and there is no compensation for the overhead of the office surgery suite. This is what we want changed. It will take the combined effort of surgeons, professional societies, the AMA and Medicare to make this happen.
There are benefits of WALANT and OBS procedures in general for the patients, the surgeons, and the medical insurance companies.
Benefits:
- Avoiding sedation or general anesthesia during hand surgery.
- Helps patient recover and return to normal activities more quickly
- Prevents the possible side effects and complications of sedation or general anesthesia, such as nausea.
- Eliminates intravenous injections.
- Eliminates the need for the patient to stop or “bridge” anticoagulant medications such as warfarin.
- Costs for patients and the medical system, and the amount of medical waste, are generally lower with WALANT.
- The wide-awake procedure also allows surgeons to assess and adjust tension for tendon transfers, check the integrity of tendon repairs, and look for gapping with active motion following flexor tendon repair.
- Postoperative pain and swelling are less.
- WALANT, as an alternative to anesthesia has been proven a safe and effective means for performing hand surgery.
- Patients who were previously not candidates for surgery due to other medical problems can now have their surgery. By eliminating the need for general anesthesia the risks have been significantly decreased—opening the door for those previously deemed “too sick” for surgery.
- Patients feel normal immediately after surgery. Unlike general anesthesia, WALANT eliminates uncomfortable side effects such as nausea or prolonged sedation.
- Fasting is not usually required. Patients can eat or drink something light the morning of surgery.
- The surgical process is shortened. Preoperative anesthesia planning and a postoperative recovery are eliminated from the surgical process.
- Medications do not need to be stopped. Lidocaine and epinephrine do not interfere with most medications that are commonly used, including blood thinners.
- Patients save time and money. Preoperative blood work and medical tests are rarely needed. In addition, the fees for anesthesia are eliminated.
- Patients can communicate with their surgeon during and after surgery. Patients know what is going on during surgery and they receive post-operative instructions immediately after their surgery is over. Patients are also able to demonstrate limb function during the procedure per the surgeon’s request, allowing for immediate evaluation of the treatment.
- WALANT is available for many surgical procedures, including carpal tunnel, trigger finger, de Quervains’ release, tendon repairs, hand and finger fractures, mass excisions, and the treatment of some arthritic conditions of the hand.