Hand Surgery
The complexity of the hand requires a surgeon with an intimate understanding of fine anatomy. Whether restoring function after an injury or rejuvenating the appearance of aging hands, we provide the meticulous care your hands deserve.
The complexity of the hand requires a surgeon with an intimate understanding of fine anatomy. Whether restoring function after an injury or rejuvenating the appearance of aging hands, we provide the meticulous care your hands deserve.
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) — is sometimes performed in the surgeon's office.
The key is lidocaine with epinephrine: typically 0.5 to 1 percent lidocaine 1:100,000 or 1:200,000 with epinephrine. Epinephrine extends the action of local anesthesia and, as a vasoconstrictor, controls bleeding. For decades, dentists have safely used lidocaine with epinephrine to control bleeding during procedures. Although surgeons were long taught that the use of epinephrine with lidocaine was unsafe in the hand, multiple well-executed studies have disproved that myth.
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.
Avoiding sedation or general anesthesia during hand surgery typically:
