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Jab that keeps you awake for complex hand surgery

It may sound daunting – especially for the more squeamish – but NHS patients are now routinely offered complex hand surgery while wide awake, with doctors claiming the method is faster and safer than surgery with a general anesthetic.

Instead of falling asleep, injections containing an anesthetic topical anesthetic and adrenaline are used, which temporarily reduce blood flow.

During the procedure, patients are conscious, they can talk and, if they wish, they can even see what’s going on.

During the procedure, patients are conscious, they can talk and, if they wish, they can even see what's going on

During the procedure, patients are conscious, they can talk and, if they wish, they can even see what’s going on

And, unlike general anesthetics, which carry deductibles and take hours of recovery time, patients can go home within an hour.

The technique is well established and widely used in emergency departments, where patients may need immediate surgery.

Minimal personnel is required and it can be performed outside the large operating rooms.

During the pandemic, many hand surgeries were performed this way, because it allowed surgeons to continue operating while faced with staff shortages and reduced theater capacity.

Matthew Gardiner, plastic surgeon advisor at Wexham Park Hospital in Slough, says, “The coronavirus pandemic accelerated the use of the technique overnight.

Surgeons who were comfortable with the traditional way have embraced it. The great thing is that it doesn’t require specific training beyond what we already know, and it’s like injecting local anesthetic after all, which we do on a routine basis anyway. ‘

The traditional method of hand and arm surgery, which uses general anesthesia, also involves the use of a tourniquet attached around limbs to apply pressure and shut off blood flow.

This minimizes bleeding so surgeons can perform repairs without interruption.

However, the tourniquet can strain healthy tissue and in some cases damage nerves and muscles. “It crushes the muscle, and there is a limited amount of time you can use it for – normally about two hours,” said Mr. Gardiner, a surgical specialty from the Royal College of Surgeons of England for plastic and hand surgery.

The new technique is known as Wide-Awake Local Anesthesia, No Tourniquet or WALANT.

Patients receive the anesthetic and adrenaline injection at the site of the injury to their arm or hand. The anesthetic quickly numbs the area so they can’t feel anything, while the adrenalin acts in a similar way to a tourniquet, sealing the blood vessels – the tiny tubes that carry blood around the body – to minimize bleeding.

Patients receive the anesthetic and adrenaline injection at the site of the injury to their arm or hand. The anesthetic quickly numbs the area so they can't feel anything, while the adrenaline acts in a similar way to a tourniquet, sealing the blood vessels - the tiny tubes that carry blood around the body - to minimize bleeding

Patients receive the anesthetic and adrenaline injection at the site of the injury to their arm or hand. The anesthetic quickly numbs the area so they can't feel anything, while the adrenaline acts in a similar way to a tourniquet, sealing the blood vessels - the tiny tubes that carry blood around the body - to minimize bleeding

Patients receive the anesthetic and adrenaline injection at the site of the injury to their arm or hand. The anesthetic quickly numbs the area so they can’t feel anything, while the adrenaline acts in a similar way to a tourniquet, sealing the blood vessels – the tiny tubes that carry blood around the body – to minimize bleeding

It takes about 30 minutes for it to take effect and the area turns white and cold. After the procedure, blood flow returns on its own after a few hours and there is no damage to tissues. The technique is suitable for surgery to repair tendons and hand fractures or other injuries, but can also be used for common hand problems, such as carpal tunnel syndrome, caused by excessive pressure on a nerve in the wrist.

While some patients are afraid to stay awake during their surgery, Mr. Gardiner says it can be a very relaxing experience. “Some patients are a bit squeamish and they don’t want to watch, but many just listen to music and fall asleep,” he adds.

Christopher Stone, 50, from Lymington in Hampshire, had surgery to repair three tendons in his left hand earlier this month after cutting them in a DIY accident with an angle grinder.

The married father of four says, “With my right hand I was able to put pressure on the opening – because it really opened and spurted blood – which held the opening together.” He was taken to the emergency room by ambulance and referred to Mr. Gardiner in Wexham Park, who ordered him to undergo surgery under local anesthesia.

“I’m not very good with blood, so I was a bit worried at first,” said Mr. Stone. “But during the procedure, the doctors were fantastic, they talked me through everything they did. When the surgeon sewed my tendons together, he asked if I wanted to take a look. He moved my fingers and you could see my tendons sewn together, moving. ‘

Ten minutes after the two-hour operation, Mr. Stone walked around and left the hospital within an hour. He says, “It went very fast, and although I didn’t feel on top of the world, I was surprised by how good I felt after that.”

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