title: [The "Wide Awake Approach" in hand surgery: a comfortable anaesthesia method without a tourniquet].
abstract: BACKGROUND
  The prohibition against the use of local anaesthetics in combination with adrenaline in hand surgery focused on publications of the past is lacking. Many recent publications show good results using adrenaline in hand surgery, especially no higher rate of skin necrosis was seen. Based on this, we started using the "wide awake approach" in elective outpatient hand surgery in 2008.
  
  
  OBJECTIVE
  The goals of this retrospective study are twice, to evaluate a) whether the use of local anaesthesia with adrenalin in selected outpatient hand surgical procedures will not - as reported in the recent literature - lead to a high complication rate, and b) the patient?s satisfaction with the 'wide awake approach".
  
  
  METHODS
  From 2/2008 to 1/2009 151 patients underwent carpal tunnel release, release of the first extensor compartment, and trigger finger release using the "wide awake approach" without use of a tourniquet. The mixture for local anaesthesia was lidocain 1% together with adrenaline (1:100 000). In spring 2009 the patients answered a questionnaire with items about pain (VAS), comfort and complications. In addition the patients were asked, whether they would choose the "wide awake approach" again.
  
  
  RESULTS
  We received 119 questionnaires (78.8%). Pain during injection of the local anaesthetics was on average 2.86 (0-10) at the VAS, and 0.88 (0-10) during the procedure itself. 12 patients (10%) needed a second shot of the local anaesthetics. 95 (79.9%) patients felt "extremely well" or ""well", 24 (20.1%) felt ""less well" or "extremely less well" during the operation. 83% of the patients would choose this form of anaesthesia again, if a further operation is necessary; 9% would prefer another form of anaesthesia.
  
  
  CONCLUSIONS
  The so called "wide awake approach" with the use of local anaesthetics added with adrenaline in the elective hand surgery is a safe and comfortable anaesthesia method. There are no valid reasons to adhere to the prohibition against the use of local anaesthetics with adrenaline in hand surgery.
authors.affiliation: Klinik für Plastische-, Hand- und Rekonstruktive Chirurgie, Kliniken des Main-Taunus-Kreises GmbH, Krankenhaus Bad Soden, Bad Soden am Taunus.
authors.forename: W H H
authors.initials: WH
authors.lastname: Koegst
authors.forename: O
authors.initials: O
authors.lastname: Wölfle
authors.forename: K
authors.initials: K
authors.lastname: Thoele
authors.forename: M
authors.initials: M
authors.lastname: Sauerbier
mesh_terms: D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local / Q000379:methods*; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D053684:De Quervain Disease / Q000601:surgery*; D004837:Epinephrine; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D014111:Tourniquets; D052582:Trigger Finger Disorder / Q000601:surgery*
chemical_list: D008012:Lidocaine; D004837:Epinephrine