Wide-Awake Hand Surgery

Wide-Awake Hand Surgery By Dr. Michael Pensak, Old Bridge and Toms River NJWide-awake hand surgery continues to gain in popularity as a treatment option for a number of common hand conditions. The technique, known as WALANT (wide-awake local anesthesia, no tourniquet), allows us to perform many procedures in a more comfortable manner, without the need for sedation or general anesthesia.

How It Works

The key to wide-awake hand surgery is the use of lidocaine with epinephrine. Epinephrine extends the action of lidocaine, a local anesthetic. It also acts as a vasoconstrictor to control bleeding, so tourniquets are not required. It was once taught that lidocaine with epinephrine should not be utilized in the hand, however multiple well-performed studies have disproved this myth and shown them to be safe. Dentists have utilized epinephrine to control bleeding during procedures for decades.

The Advantages

Here are seven advantages for undergoing a hand procedure using the wide-awake technique.

  1. Sedation or general anesthesia is not used for wide-awake hand surgery. For patients with medical conditions that make them high risk for surgery, the avoidance of general anesthesia can allow them to undergo procedures that they might not otherwise be eligible for.
  2. Avoiding sedation benefits healthy patients too. Healthy patients undergoing wide-awake hand surgery are often able to return to their regular daily activities after the procedure, because they don’t experience common side effects such as nausea, vomiting, and general fatigue. Some patients even opt to return to work the same day.
  3. Many patients appreciate that there is no IV placed and the local anesthetic is administered with a very small injection using a pain-free technique.
  4. Patients are able to avoid fasting, lab work, a preoperative history and physical appointment, and the stoppage of medications, including blood thinners.
  5. Recovery from wide-awake hand surgery is often less painful with reduced bruising and swelling.
  6. Less narcotic pain medications required postoperatively.
  7. If the procedure involves fracture fixation or tendon repair, we can test the repair and determine postoperative therapy treatment during the procedure. Allowing the patient to actively participate in their procedure because they are awake allows us to get things “just right” before leaving the operating room which results in optimal outcomes.


While not every procedure can be performed with wide-awake hand surgery, there are a significant number that qualify and the number of conditions continues to increase. Here are the conditions that can often be treated with wide awake surgery right now:

  • Nerve compression
  • Tendon disorders or repairs
  • Ligament repairs
  • Fracture fixation
  • Arthritic conditions
  • Mass removal.

Dr. Pensak is proud to offer wide-awake hand surgery to optimize patient experiences and outcomes. If you would like to discuss wide-awake hand surgery as an option for your hand condition, please call for an appointment with Dr. Pensak.