title: Putting it all together: recommendations for improving pain management in plastic surgical procedures: hand surgery.
abstract: BACKGROUND
  Approaches to upper extremity anesthesia in hand surgery include regional blocks, wide-awake hand surgery with local anesthesia, and stellate ganglion blocks.
  
  
  METHODS
  Retrospective review of the literature from 2000 to 2014 published on the delivery of local and regional anesthesia during hand surgery. Included studies describe techniques of administration and treatment outcomes to identify common practices of pain management in hand surgery.
  
  
  RESULTS
  Regional blocks provide sufficient anesthesia for hand surgery and have been found to improve postoperative pain and measured outcome scores. Wide-awake surgery offers many advantages including minimizing anesthetic risk and expense, permitting patient participation in operative evaluation, decreasing hospital time, and improving functional outcomes scores.
  
  
  CONCLUSIONS
  Pain management in hand surgery can be achieved through regional blocks and wide-awake techniques that do not necessitate general anesthesia in an effort to improve safety, convenience, cost savings, and efficiency.
authors.affiliation: Baltimore, Md. From the Curtis National Hand Center, MedStar Union Memorial Hospital.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Albino
authors.forename: Christopher
authors.initials: C
authors.lastname: Fleury
authors.forename: James P
authors.initials: JP
authors.lastname: Higgins