[Wide awake hand surgery based on application examples].

OBJECTIVE: Anesthesiologic method with low bleeding level, risk level, and complication rate for surgical procedures on the hand without a tourniquet on an unsedated patient with the possibility for functional testing during surgery. INDICATIONS: Surgical procedures of the hand can be carried out using the wide awake technique depending on the patient's suitability and preference considering individual risk factors. CONTRAINDICATIONS: Absolute contraindications are allergies to the local anesthetic or its components. Relative contraindications are severe hepatic or renal insufficiency, infections in the injection area, acute circulatory disorders, or higher cardiac function impairment. INJECTION TECHNIQUE: Infiltration of a lidocaine/epinephrine mixture with 8.4% sodium bicarbonate in a ratio of 10:1.5 at least 30 min prior to surgery. Perpendicular puncture of the skin and slow injection. Continue injection until reaching a pale skin area of at least 1 cm around the entire operating area. If the needle tip always remains in a cushion of local anesthetic, a "hole-in-one" anesthesia can be achieved (only the first needle puncture is felt). POSTOPERATIVE MANAGEMENT: Elevated care and awareness for numb body parts by the patient because of impaired sensation. Follow-up treatment according to the surgeon's specifications. Postoperative use of painkillers.
RESULTS: Of 38 patients, 32 felt that the procedure was not stressful, 6 rated it as a bit stressful. Pain perception on a visual analog scale (0 = no pain, 10 = severe pain) scored an average of 1.6 during infiltration, 0.5 during the operation, 3.5 during the reduction of the anesthesia, and 2.9 on the following day. All patients would undergo surgery again using the wide awake technique.