In Office Procedures

The hand and wrist orthopedic surgeons, Dr. Lonnie J. Moskow and Dr. Amar A. Patel, at South County Orthopedic Specialists (SCOS) in Orange County, California, are pleased to announce that we now offer minor hand surgery in the office. With advances in local anesthesia, minor procedures can be accomplished while the patient is fully awake.

In traditional hand surgery, general anesthesia and a tourniquet are necessary to provide better visibility for the surgeon and control bleeding. But, the tourniquet is uncomfortable and unnecessary when the Wide Awake Local Anesthetic No Tourniquet (WALANT) technique is used.

With the advent of WALANT, only two medications are used for anesthesia.  Lidocaine local anesthesia for pain and epinephrine to constrict the blood vessels which reduces bleeding to improve the surgeon’s visibility, and eliminates the need for a tourniquet. This is essentially the medication used in dentistry for dental procedures, with no preoperative testing, no monitoring, no IV sedation, and few adverse events.

Benefits of WALANT:

• Avoids the need for and costs of a hospital stay or an outpatient surgery center
• Eliminates medical workup, IV insertion, monitoring, and general anesthesia
• Eliminates the need for pain killers like opiates which can become addictive
• Eliminates the need for someone to stay with the patient after surgery
• Patients can interact with their surgeon, see the repairs and how they work during surgery, which helps to motivate patients for post op therapy and recovery
• No cost of time out of work for preoperative testing or surgery
• No unnecessary IVs
• No need to fast in preparation for general anesthesia
• No need to change a patient’s medications for surgery
• Patients with multiple medical problems can undergo WALANT and be monitored safely and easily
• When surgery is complete, patients can leave without the need to recover from anesthesia

Since patients are not sedated, they can help the surgeon during surgery, particularly where the surgeon is repairing tendons and bones.  With the wide awake patient’s cooperation, the surgeon can be sure everything is working correctly. Recovery is also quicker and less painful.

The benefits of no sedation:

• Increased safety, less expense and shorter surgeries
• No need for sedation- which was given so the patient could tolerate the tourniquet and injection of local anesthetic. New injection techniques cause minimal pain.
• More patients can afford hand and wrist surgery when sedation costs are eliminated.
• Convenience – the patient can drive himself to and from the procedure
• Patients can eat before surgery and don’t have to worry about “going under”.
• Wide-awake patients report little pain and anxiety
• Wide awake surgery eliminates the need for a tourniquet. This greatly improves results for minor hand and wrist procedures.

WALANT at SCOS:  Our hand specialists commonly use this technique for the following conditions amongst others:

1. Trigger finger release
2. Ganglion cyst excision
3. De Quervains Tenosynovitis

Trigger Finger Release

The tendons of the thumb and each of the fingers pass through a sheath on the palm side of the hand. Certain diseases and overuse activities can cause a thickening of this sheath. As the tendon passes through a thickened sheath, it eventually becomes irritated and swells. Pain, catching and eventually locking of the finger will occur. Early treatment consists of anti-inflammatory medication or Cortisone injection. If these fail to provide relief, WALANT surgery can eliminate swelling, catching and locking, and allow full movement of the finger or thumb without pain.

Ganglion Cyst Excision

This type of cyst forms on the top of a joint, ligament or tendon. It is filled with fluid and is visible. It may go away on its own. But, it can also cause pain including burning, numbness or tingling, and interfere with function. The goal of surgery is to remove the cyst and restore function, as well as appearance.

De Quervain’s Tenosynovitis

Tendonitis on the thumb side of the wrist can be a very painful and disabling condition. Simple pinching, grasping and twisting activities can be almost impossible. Thumb tendons become inflamed as they pass under a ligament and the slightest motion of the wrist can cause pain. The cause is not known but can occur due to repetitive hand and thumb movements. This condition can occur at any age.

Treatment consists of rest, medication and occasionally the use of a steroid injection. If these treatments do not provide relief over time, the wide awake surgery can release the tendons, eliminate pain and restore normal function.

Wide awake hand and wrist surgery can be safely performed in the office at SCOS. After the procedure, patients receive an injection of Marcaine, a local anesthetic, which prevents pain for up to 24 hours.

The fellowship- trained hand and wrist surgeons, Dr. Lonnie J. Moskow and Dr. Amar A. Patel limit their practice to treating hand and upper extremity orthopedic conditions, and continually update their skills and knowledge of the most recent orthopedic innovations and techniques. They appreciate that patients who are awake and coherent have better outcomes, and pain-free procedures. This new approach to hand surgery empowers patients to be actively involved in their care.

Patients in Orange County, California seeking wide awake hand surgery can find this low- risk, low- cost, high patient satisfaction approach at South County Orthopedic Specialists.

Hand & Wrist Specialists

Lonnie J. Moskow, MD

Dr. Moskow is fellowship- trained in hand and microvascular surgery at the Sydney Hospital Hand Center, a world-renowned center for hand surgery in Sydney, Australia. His practice covers all aspects of hand, wrist, and elbow surgery. Read Dr. Moskow’s biography.

Amar A. Patel, MD

Dr. Patel is fellowship- trained in hand and microvascular surgery at the prestigious Indiana Hand to Shoulder Center, the largest hand surgery training center in the world. His practice covers all aspects of hand, wrist, and elbow surgery. Read Dr. Patel’s biography.