Dr. Steven Yang,聽Clinical Associate Professor, Department of Orthopaedic Surgery, helped spearhead 嘿嘿视频's new "wide-awake" outpatient hand surgery program.
Photo: Karsten Moran
In most hospitals, surgery on the hand and wrist is usually performed using regional anesthesia and intravenous sedation, or general anesthesia. Patients must undergo preoperative tests, fast starting the night before, and spend an hour or more in a recovery room. In September, 嘿嘿视频 became one of the first medical centers in the US to change those protocols. At the on East 38th Street, a new operating room is dedicated to 鈥渨ide-awake鈥 hand surgery, which allows many of these surgical procedures to be performed 鈥渁s quickly and easily as a trip to the dentist,鈥 explains orthopaedic surgeon , who helped spearhead the new program. 鈥淲hen patients are done, they can go home without needing an escort.鈥
With outpatient surgery becoming increasingly common, why is that so unusual? Traditionally, hand and wrist surgeons have used an arm tourniquet to limit bleeding, but the pressure it causes is often so uncomfortable that medication is required to make it tolerable. Alternative approaches that don鈥檛 use a tourniquet have long been limited because physicians were reluctant to use epinephrine颅鈥攁 drug that constricts blood vessels and prolongs the effect of local anesthetics鈥攐n the hands and wrists.
But all that has changed, thanks to a flood of studies showing that epinephrine is safe, and a technique in which epinephrine blended with a local anesthetic eliminates the need for a tourniquet. Surgery on the hand or fingers can now be performed without an IV, sedatives, or preoperative testing.
With 17 board-certified hand surgeons, 嘿嘿视频鈥檚 is the largest program of its kind in the country, performing more than 5,000 procedures annually. Wide-awake surgery is used for a range of operations, from the excision of a or a release to more complex procedures. The new technique can also improve outcomes. A fully conscious patient can move their hand and fingers, enabling the surgeon to assess the results in real time. The surgeon can also communicate with the patient, soothing any nervousness. The only pain is the sting of the initial shot.
