How the wide awake approach is changing hand surgery and hand therapy: inaugural AAHS sponsored lecture at the ASHT meeting, San Diego, 2012.

The wide awake approach to hand surgery means that the patient is unsedated for up to 95% of all hand surgery procedures. For the patient, the experience is reduced to the equivalent of a visit to the dentist where no preoperative tests are required, only lidocaine with epinephrine is injected, and where they get up and go directly home after the procedure.1 This is made possible by the recent advance of ample evidence that it is safe to inject epinephrine (adrenaline) in the human finger.2e8 Epinephrine decreases the bleeding so that the hand surgeon can easily do the surgery without the need for a tourniquet. Deleting the tourniquet negates the need for tourniquet pain, sedation or general anesthesia for hand surgery. Lidocaine provides all of the numbing required to eliminate the pain of surgery. Other recent advances in local anesthetic injection techniques have also rendered the pain of local anesthetic injection to a minimal level,9,10 even when large areas need to be injected as occurs in bigger hand, wrist, and forearm operations. This approach has gained rapid popularity in Canada11 where access to anesthesiologists and main operating theater time has been limited. It is rapidly spreading throughout the United States, Europe, Asia, South America, and Africa.