Apr 13, 2016 3 min read

1 / 5

A patient is injected with a local anesthetic before undergoing wide-awake hand surgery.

Courtesy of Dr. Gerson Florez

2 / 5

The area of the incision is marked on the hand of the patient undergoing carpal tunnel and trigger thumb release surgery.

Courtesy of Dr. Gerson Florez

3 / 5

The patient remains awake and alert while surgeons perform carpal tunnel and trigger thumb release surgery.

Courtesy of Dr. Gerson Florez

4 / 5

After surgery, patients do not have to go to a recovery area while anesthesia wears off, and they can drive themselves home.

Courtesy of Dr. Gerson Florez

5 / 5

Dr. Gerson Florez

[expand]

close

A new innovation in health care has made it possible for patients undergoing hand surgery to remain alert during their procedures.

Dr. Gerson Florez admits wide-awake surgery isn’t for the squeamish. But for those for whom orthopedic surgery might not otherwise be possible, the innovation is a worthwhile consideration.

“Personality has a lot to do with it,” said Florez. “The older generation can be very tough mentally, so it’s a fantastic option for older people.”

An orthopedic surgeon focusing on hand, elbow and shoulder issues, Florez has performed a handful of sedation-free surgeries at Monongahela Valley Hospital. He predicts this type of procedure – common in Canada – will soon be standard procedure in the United States.

According to a National Library of Medicine journal, more than 95 percent of all hand surgeries can now be performed without a tourniquet and sedation.

In traditional surgery, patients must first have expensive tests, including an electrocardiogram and chest X-ray. They can’t eat or drink for hours before the procedure. They must have someone drive them to and from the hospital.

Once anesthesia takes effect and they are unconscious, a tourniquet is applied above the site of the surgery so that the field is bloodless.

The patient is then awakened in the recovery room and can be nauseous and have a headache. Older patients can also experience confusion.

“I always hear, ‘I don’t know what happened. Did you do the surgery?'” said Florez. “With wide-awake surgery, confusion is completely eliminated. People know exactly what happened.”

When patients choose sedation-free surgery, they can eat breakfast, take their medications and drive themselves to the procedure. There is no pre-operative testing.

After a local anesthetic is administered into the site, the area is draped so the patient doesn’t have to watch. Patients listen to the music of their choice and communicate with Florez and his staff during the procedure.

“They can feel their hand move, but there is no pain,” he said.

Florez recently operated on a 90-year-old woman with great results.

“She didn’t have the ability to have the surgery because, with anesthesia, it was too much of a risk. She was having pain and numbness in her hand but, physically, couldn’t handle anesthesia,” Florez said. “She was a little squeamish that she was going to know everything going on (during surgery.) But she was happy she got it done and thankful we didn’t give up.”

Florez said it’s also a great option for patients who have diabetes because they don’t have to worry about blood-sugar fluctuations due to skipping breakfast.

And with this option, Florez can test the repair by having patients move their hand.

“It actually improves results,” he said.

Another benefit is the lack of pain following the procedure. After traditional surgery, many patients experience pain from the tourniquet, which is eliminated with wide-awake surgery.

Florez said this innovation signifies the future of orthopedic surgery. He predicts these types of procedures will eventually be performed in the doctor’s office, instead of operating rooms.

Florez will present “Innovations in Wide-Awake Surgery” at 6 p.m. March 24, at Monongahela Valley Hospital for the “Innovations in Medicine” community series. To register for this free program, call 724-258-1333.