Over the last 10 years, the concept of “WALANT” has greatly reduced the importance of sedation and general anesthesia for hand surgery. Many surgeons have transitioned towards performing wide-awake, local-only anesthesia with or without a tourniquet. In many cases, this has allowed for a reduction in cost by transitioning procedures to the office setting, a reduction in cost by avoiding surgery center facility fees, and reducing the patient complications and inconvenience of sedation.
However, WALANT technique is most commonly used for “smaller” hand cases: carpal tunnel, trigger fingers, tendon surgery in palm or fingers, etc. Although some surgeons have utilized WALANT technique for distal radius fractures and other forearm or elbow injuries, this is not widely practice. Rather, most surgeons perform upper extremity fracture fixation under regional anesthesia with sedation or general anesthesia.
Manu member Dr. Orrin Franko has been utilizing surgeon-administered, axillary regional anesthesia, taught to him by his partner Dr. Andrew Stein, since starting practice 3.5 years ago. Dr. Stein has been performing this technique for over 20 years, with over 3,000 blocks performed. Since learning the technique, Dr. Franko has performed these axillary blocks over 300 times with no known complications or failures. Traditionally the regional blocks are performed in the operating room under anesthesiologist-monitored light sedation (propofol), with additional local anesthetic given at the operative site for patient comfort during the incision as the block sets up.
Recently, both Dr. Franko and Dr. Stein have been performing “wide awake” regional blocks using the same injection technique. They have found that patients can tolerate the injection without much discomfort, and the block will set up within 25 minutes. This avoids the need for additional local anesthesia at the operative site, permits upper arm tourniquet use without discomfort, and avoids the risks and inconveniences of sedation.
Dr. Franko has created a video demonstrating this technique in a wide-awake patient. We hope you find this educational.