Wide-Awake Anesthesia in the In-Office Procedure Room: Lessons Learned. (July 2018)

• Record Type: Journal Article
• Authors: Van Demark, Robert E.; Becker, Hillary A.; Anderson, Matthew C.; Smith, Vanessa J. S.
• Is Part Of: Hand. Volume 13:Number 4(2018)
• Page Start: 481
• Page End: 485
• Publication Date: 2018-07
• Subjects: WALANT -- wide-awake anesthesia -- in-office procedure room -- ambulatory surgery -- epinephrine -- tourniquet; Hand -- Surgery -- Periodicals; Hand -- Surgery; Periodicals; 617.57005
• DOI: 10.1177/1558944717715120
• Languages: English
• ISSNs: 1558-9447

Abstract

Background: Wide-awake local anesthesia and no tourniquet (WALANT) has become more popular in hand surgery. Without a tourniquet, there is no need for preoperative testing or sedation. The use of lidocaine with epinephrine has allowed a larger variety of cases to be done safely in an outpatient setting instead of the hospital. "Minor field sterility, " which uses fewer drapes and tools to accomplish the same procedures, is a concept that is also gaining recognition.Methods: Investigation of hand surgeons performing a majority of cases using WALANT and minor field sterility was the beginning of seeing its potential at our institution. Administration was concerned about patient safety, cost-effectiveness, and patient satisfaction of the proposed changes. Analysis of our institution to determine location of these procedures was also imperative to using WALANT.Results: An in-office procedure room was built to allow for WALANT and minor field sterility. The requirements and logistics of developing an in-office procedure room for wide-awake surgery are reviewed in this article.Conclusions: The concurrent use of WALANT and minor field sterility has created a hand surgery practice that is cost-effective for the patient and the facility and resulted in excellent patient outcomes and satisfaction.