‘Wide awake’ hand surgery eyed as a game-changer

Dr. Joe Pannatoni [Photo: Denise Ritchie]

Hand surgery can be incredibly complex.

It’s also very common and seniors needing hand surgery often face a slew of obstacles that younger patients don’t.

According to Vero Orthopaedics & Neurology’s Dr. Joao (Joe) Panattoni, a fellowship-trained hand surgeon and microsurgery expert, the procedures to treat conditions such as “trigger finger,” carpal tunnel syndrome, trauma injuries and tendonitis can be tricky in an aging demographic.

Simply put, the older we get, the more co-morbidities we develop.

People on blood thinners or those for whom general anesthesia poses a serious risk need an alternative to traditional surgeries and Panattoni says he has one.

It’s called WALANT surgery.

WALANT stands for “wide awake local anesthesia no tourniquet” surgery; in Panattoni’s eyes, it’s something of a game-changer.

The Mayo Clinic agrees.

“The ability to safely control bleeding and extend the duration of local anesthesia,” says the Rochester, Minnesota, clinic, “allows hand surgeons to perform many procedures with minimal bleeding and without the use of sedation, general anesthesia or a painful tourniquet to control bleeding.”

Indeed, the Cleveland Clinic points out that “the common and universally accepted practice of hand surgery [usually] consists of applying a forearm or arm tourniquet to allow for a bloodless surgical field.

“The operative site is often injected with local anesthetic and sedation is needed to offset the pain generated by the applied tourniquet,” but when using the WALANT technique, according to the Ohio-based institution, “surgical cases can be accomplished in an office setting,” rather than a hospital operating room.

Using a combination of lidocaine and epinephrine at the area of incision, surgeons like Panattoni can provide patients with the needed constriction of blood vessels, as well as up to four hours of pain relief.

Better still, Cleveland Clinic continues, “by eliminating those operating room and anesthesia costs, WALANT significantly diminishes the overall cost of care [and] patients may leave immediately after the surgical procedure, without the negative side effects and inconveniences of sedation.”

“The more available options you have to offer the patient the better, because then you can work on patients that have high co-morbidities and cannot really go to the hospital,” says Panattoni. “Some patients cannot stay off their blood thinners and some of them cannot even be cleared to have surgery or anesthesia done, yet they’re still suffering and having problems.”

WALANT may well be the best option for these patients.

Panattoni credits Dr. Donald Lalonde, a past president of both the American and Canadian associations for hand surgery and the Royal College of Physicians and Surgeons of Canada, for popularizing the procedure among both countries’ aging demographic.

But seriously. Who wants to be “wide awake” during any surgery?

To some the idea of watching your surgeon operate on the tendons, bones, ligaments and such inside your hand might seem almost ghoulish, but Panattoni bushes that concern aside.

“The idea is not [for patients] to watch me operate,” he says, but adds, that a ‘wide awake’ patient can help in the procedure. Panattoni covers the incision area so the patient doesn’t have to watch, but the doctor can ask the WALANT patient to, for instance, make a fist so he can – instantaneously – check to see if his repairs are working properly before closing the incision.

“We give the patient what they need and what’s best for them and what makes them happy. If they say, ‘No, I don’t want to be awake. I want an endoscopic procedure,’ we can offer that option, too.”

So far Panattoni has performed over 100 WALANT hand procedures in the Vero Beach area and he adds, “We keep it safe for the patient, of course, and we have been having good results and good outcomes.”

Dr. Joao (Joe) Panattoni is with Vero Orthopaedics & Neurology with offices at 1155 35th Lane in Vero Beach and 801 Wellness Way in Sebastian. The phone number in Vero is 772-569-2330. In Sebastian it’s 772-388-9510.

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