Eric Taris, MD, a hand surgeon at Appalachian Orthopedics in Johnson City, Tenn., is structuring part of his week entirely around wide-awake, local-anesthesia, no-tourniquet — known as WALANT — procedures, he told Becker’s.
Starting this fall, Dr. Taris will spend Monday mornings in clinic performing wide-awake cases such as carpal tunnel releases, trigger finger releases and cyst excisions, then move to the surgery center in the afternoon for local-only procedures without anesthesia support.
“My whole Monday right now is going to be all wide-awake,” Dr. Taris said, adding that the schedule could evolve over the year but wide-awake care will remain a fixed part of his week.
The technique uses lidocaine and epinephrine to control bleeding instead of a tourniquet and eliminates the need for an anesthesiologist for many hand and below-elbow procedures, freeing operating room time for cases that require sedation, Dr. Taris said.
“It decreases their bill because they don’t need anesthesia,” he said, adding that patients also avoid needing a driver and can eat the morning of surgery.
Dr. Taris said he trained extensively in the approach during his fellowship in hand surgery at Dayton, Ohio— based Kettering Health, where he said faculty were early adopters of the technique.
For most patients, wide-awake care is limited to smaller procedures such as flexor tendon injuries or minor fracture fixation, Dr. Taris said. He said he would rarely use the approach for a larger fracture repair unless a patient had comorbidities that made general anesthesia too risky, since numbing a patient for a bigger case can take up to 30 minutes.
“It just takes a lot of process, but it can be applied to a patient who uses their hand for function and has a lot of comorbidities and can’t undergo anesthesia,” he said.
Dr. Taris said the approach is largely confined to hand and wrist surgery for now, since nerves above the elbow are deeper and harder to fully numb without an anesthesiologist placing a block. He said he expects more hand surgeons to adopt wide-awake techniques going forward, driven partly by anesthesiologist shortages and delays, as well as the broader shift of procedures into outpatient settings.
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