Wide Awake Hand Surgery

You may not think of hand surgery as a procedure done with the patient awake, alert, and feeling comfortable, but medical and technological innovations have made this type of surgery a preferred option for many common hand conditions.

Hand surgery while fully awake is a safe and convenient option with many benefits. Similar to a dental procedure, the area is completely numbed while the patient is awake and alert. After the procedure, the patient may simply get up and go home. There is no need for sedation, general anesthesia, or an IV. Wide awake surgery can be performed in the office or operating room.

Local injection is the safest type of anesthetic, and allows patients considered high-risk for general anesthesia to safely undergo procedures. Additionally, patients do not need to fast or stop any medications before surgery, and do not experience unwanted side effects of general anesthesia, like nausea, vomiting, and urinary retention.

How it works: Lidocaine with epinephrine is injected at the surgical site to numb the area and reduce blood loss. Patients feel a small prick and some mild burning as the anesthetic is administered. The numbing process typically takes less than a minute. The area is immediately numbed, and the medication lasts about three to four hours.

Patients who undergo wide awake surgery may drive themselves home, and some may even return to work the same day. Recovery is typically less painful than surgery performed under general anesthesia, with less medication needed to manage pain afterward. There are also decreased costs associated with procedures performed this way.

It also allows for more interaction between the surgeon and the patient, offering patients greater peace of mind and allowing surgeons to ensure their patients know what is happening throughout the procedure.

At UTMB Health, we use this method to perform a variety of hand surgeries, including carpal tunnel release, trigger finger release, De Quervain’s release, tendon repairs, and skin excisions. Other procedures, including fracture fixation and arthritis treatment, may be performed wide awake on a case-by-case basis. Our surgeons can determine if wide awake surgery is the best option for any patient and procedure.

Daniel Donato, MD, is an Assistant Professor of Plastic Surgery, specializing in hand surgery, in the UTMB Health Department of Surgery.

Surgical Services