Wide-Awake Surgery

Jul 25, 2013

Dr. Michael Dolan performs wide-awake carpal tunnel surgery on a patient.

Hand surgeon offers carpal tunnel surgery with numbing medicine rather than general anesthesia

Dr. Michael Dolan at West Tennessee Bone & Joint Clinic is offering a new kind of hand surgery that many in the medical community thought was impossible a few years ago.

Instead of general anesthesia, Dr. Dolan injects a mixture of lidocaine and epinephrine into the wrist of patients to numb the area for surgery. Although dentists commonly use the injection, medical students were taught for decades not to inject epinephrine – or adrenaline – into the hand, Dr. Dolan said.

“It’s something totally new,” said Dr. Dolan, who is board certified in both general surgery and hand surgery.

Epinephrine constricts blood vessels, which allows the localized numbing effects of lidocaine to last longer, but the medical community feared for a long time that it would restrict blood flow to the extent of killing the hand. That has been proven wrong, Dr. Dolan said, and wide-awake hand surgery is a remarkably easier experience for patients.

Patients do not have to abstain from eating or drinking. They keep their street clothes on and receive a single shot in the wrist, which is less painful than the IV required for general anesthesia. They then sit painlessly through the procedure while Dr. Dolan carries on a conversation with them, he said.

“Then they stand up, walk out and go home.”

It is not uncommon for patients to spend a night – or more – recovering in the hospital after general anesthesia. The required prep work also can require them to arrive at the surgery center hours in advance.

General anesthesia is also a vascular stressor, Dr. Dolan said, and patients often feel as if they have just run a race. With wide-awake surgery, the numbness of the lidocaine wears off after about six hours.

Patients are injected with Marcaine after the procedure, which prevents them from experiencing pain for another 24 hours. By that time, the pain is gentle enough that it can be treated with ibuprofen.

Some patients have had the wide-awake procedure on their lunch break and returned to work for the rest of the day, Dr. Dolan said. And, because the recovery period is less painful, patients often don’t need the regimen of painkillers that can become addictive and that are associated with the aftermath of traditional surgery, he added.

“Many people go through the wide-awake surgery without a single narcotic.” General anesthesia also carries the risk of complications that could be fatal. As a result, wide-awake surgery is safer. It’s also cheaper for patients and faster for doctors to perform, he said.

“It allows us to get patients in and out of the operating theater much quicker.”

Dr. Dolan has performed wide-awake surgery on patients from ages 12 to 95, though, typically on patients with carpal tunnel syndrome or trigger finger. He also uses the procedure to remove a benign cyst or to repair a hand after a laceration or other trauma.

He has been performing the procedure since 2010.

“We’ve all just been wowed about it because the patients just do so well,” Dr. Dolan said.