Jean Paul Brutus

Background: Minimally painful tumescent local anesthesia ensures patients feel only the first needle insertion, with no further pain. This technique includes real-time patient feedback, where they report each pain event during injection. Methods: This prospective study involved 154 consecutive patients undergoing wide-awake local anesthesia no tourniquet surgery at 3 hand surgery centers (January–April 2024). Patients objectively scored pain events during injection and rated pain intensity (0–10 Likert scale), intraoperative pain, anxiety, and overall experience. Results: During local anesthesia injection, 61 (40%) patients reported no pain, 92 (59.7%) reported 1 pain event, and 1 (0.7%) patient reported 2 events. Among the 93 patients who felt pain, 90 reported only mild discomfort (1–2 of 10), whereas 3 reported moderate pain (3–5 of 10). Anxiety levels during anesthesia and surgery were 3 of 10 or less for 147 (95.5%) patients. Conclusions: Real-time patient feedback improved surgeons’ ability to administer tumescent local anesthesia with minimal pain. As a result, most patients experienced no pain or only 1 minor event during local anesthesia injection for wide-awake local anesthesia no tourniquet surgery.

Summary: In the evolving landscape of ambulatory surgery, wide-awake local anesthesia no tourniquet (WALANT) surgery has emerged as a preferred approach due to its efficacy, cost-effectiveness, and patient satisfaction. This paradigm shift places the patient at the center of intraoperative communication, requiring a significant change in the dialogue within the operating room (OR). Traditional conversations, which often exclude the unconscious patient, must evolve to accommodate and prioritize the psychological comfort of the conscious patient. This article examines the impact of language, tone, and conversation content on the patient experience during WALANT. We propose a communication framework that emphasizes empathy, reassurance, and patient inclusion to reduce anxiety and increase patient compliance. By analyzing common OR dialogues and their potential impact on awake patients, we identify specific phrases and words that may exacerbate patient stress or discomfort. Alternatives are suggested to foster a more positive and inclusive environment. Our recommendations are based on extensive clinical experience and supported by relevant literature, highlighting the critical role of mindful communication in improving clinical outcomes and patient satisfaction in WALANT.

Summary: Fasciectomy for Dupuytren disease is a common procedure traditionally performed with a tourniquet under general or regional anesthesia. Since the year 2001, the wide-awake local anesthesia no tourniquet (WALANT) approach has been applied successfully to Dupuytren surgery, with current excellent surgeon and patient satisfaction. However, using WALANT for Dupuytren surgery may be intimidating for hand surgeons who want to begin using this method. The purpose of this article is to offer a series of tips and tricks the authors have learned after having performed hundreds of WALANT fasciectomies, to make this technique easier for surgeons and a more pleasurable experience for patients.