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Wide Awake Surgery

Wide Awake surgery is a safe and effective anaesthesia technique for many hand and wrist surgeries.  For wide awake surgery sedation or general anaesthesia is not used.

 

The avoidance of general anaesthesia in wide awake surgery is advantageous for patients with medical conditions that make them high risk to undergo surgical procedures that they might not otherwise be eligible for. 

Research suggests that the postoperative recovery is rapid, and the procedure saves significant time and money because of the avoidance of preoperative testing and hospital admission.

The conditions that can often be treated with wide awake surgery are:

  • Nerve repair

  • Tendon repair

  • Ligament repair

  • Dupuytren's contractures

  • Fracture fixation

  • Arthritic conditions

  • Mass removal

Dudley Creek Health has been providing Wide Awake Surgery for the past year with great success.

Read the article :  https://metropol.co.nz/wide-awake-surgery-dudley-creek-health/ 

Please review the following links for more extensive information on Wide Awake Surgery.

https://doi.org/10.3928/01477447-20181206-01

https://doi.org/10.3390/jcm11133854

https://doi.org/10.1016/j.rboe.2017.05.006

https://doi.org/10.1016/j.jhsa.2018.03.033

https://doi.org/10.3928/01477447-20181206-01

https://doi.org/10.1016/j.jhsg.2022.05.009

https://doi.org/10.1016/j.jhsa.2021.08.026

https://journals.sagepub.com/home/HAN

http://www.biomedcentral.com/1753-6561/9/S3/A81

https://doi.org/10.1186/s13643-020-01532-1

Pre and Post
Op Information

Pre-Operative Information and Check list for WALANT

Wide Awake Procedures are performed in minor operating theatre and performed within 90 minutes from commencement. Optional medication for anxiety in the form of sedatives may be administered 30 minutes prior to surgery and repeated if necessary.

Please click here to view our full list of pre-operative surgery instructions.

Post-Operative Instructions:

Please click here to few a full list of our post-operative surgery instructions. 

Moderate Procedures under Peripheral Nerve Block

As part of your wide-awake surgery at Dudley Creek Health we utilize Regional Anaesthetic techniques also known as Peripheral Nerve blocks along with the use of very light sedatives to keep you pain free and relaxed during your operation.

 

For surgery on the upper limb a Brachial plexus nerve block is performed by the anaesthetist. The Brachial plexus is the group of nerves that lies between your neck and your armpit. It contains all the nerves that supply movement and feeling to your arm – from your shoulder to your fingertips.

Your anaesthetist will use an ultrasound to locate the nerves and inject local anaesthetic around the nerve bundles. The local anaesthetic 'blocks’ information travelling along these nerves. As it works your arm will become numb, heavy and then immobile. You can then have your operation without feeling anything. The block also provides pain relief for between 6 – 18 hrs following the injection.

Performing the nerve block

The injection for a brachial plexus block is around your collar bone and/or armpit. First a venous canulae is placed and some sedative medication is given before the injection to help you relax. The skin around the injection site is cleaned and a small injection of local anaesthetic numbs the skin. The nerves are then located using an ultrasound and the nerve block injection performed. This process takes about 10 minutes and most people find that the injection is no more painful than having the cannula inserted into a vein. Your arm will start to feel warm, heavy and numb. The injection takes between 20 and 40 minutes to work. We will make sure it is working well before commencing your operation. If the nerve block does not work fully. This may be due to the operation being more extensive than expected or due to technical difficulty with the injection. If this happens, you will be offered more local anaesthetic, often at a different site down the arm as well as additional pain relief. We do not offer general anaesthetics at Dudley Creek Health.

During the operation

Your anaesthetist remains close by. A screen is used, so you cannot see the operation, unless you want to. Please feel free to bring in a personal music player with headphones if you would like to listen to music during the operation.

Benefits of a brachial plexus block

  • Better pain relief afterwards. There may be less need for strong pain relief medicines which make some people feel quite sick and unwell.

  • Avoiding a general anaesthetic, including its risks and side effects. The common side effects of a general anaesthetic include sickness, sore throat and drowsiness.

  • Often able to leave hospital sooner.

Side-effects, complications and risks

In modern anaesthesia, serious problems are uncommon. Risk cannot be removed completely, but modern drugs, equipment and training have made anaesthesia a much safer procedure in recent years.

Anaesthetists take a lot of care to avoid all the risks given in this section. Your anaesthetist will discuss with you in more detail any of these risks and the precautions taken to avoid them.

Below are some of the side effects of the nerve block

  • Injection around the collar bone: less than 1 in 1,000 risk of damage to the covering of the lung.

  • All injection sites: damage to a blood vessel which usually resolves with simple compression to stop any bleeding.

  • Hoarse voice, shortness of breath and blurred vision may also occur

Very rarely: having a fit or another life threatening event may occur. Your anaesthetist will manage these promptly. They will tell you more about these risks during your consultation on the day.

 

Nerve damage

  • The risk of long-term nerve damage caused by a brachial plexus block is difficult to measure precisely. Studies show that it happens in between 1 in 700 and 1 in 5,000 blocks.

  • If you have a block lower down the arm, the risk of nerve damage and its consequences may be less.

  • About 1 in 10 patients notice a prolonged patch of numbness or tingling in their arm. These symptoms will resolve in 95% of these patients within four to six weeks, and in 99% within a year.

  • There is a risk of nerve damage after any operation regardless of whether you have had a block. This can be due to the operation, the position you lie in or the use of a tourniquet (tight band on the upper arm which prevents bleeding during the operation). Swelling around the operation site or a pre-existing medical condition, such as diabetes, may also contribute to nerve damage.

References.

 

RCOA Patient information, Nerve blocks for surgery on the shoulder, arm or hand .2015.

 

Oxford Handbook. Emergencies in Aneasthesia 3rd Edition. 2019.

Post Operative Information

You should keep your arm in the sling you are given for support and protection until the nerve block has fully worn off.

You will not be fully aware of the position of your arm – so it can be injured without you realising.

  • Be especially careful around heat sources, such as fires or radiators. You will not feel heat while your arm is numb and burns can happen.

  • Avoid use of any machinery or domestic appliances.

  • Start taking your prescribed pain relief medicines Before the block wears off. This is important as the pain can appear quite suddenly.

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