As part of his initial vision for bringing an integrated, patient-centered hand clinic to this area, Dr. Gorman saw the benefit of providing the region’s first in-office hand surgical suite. For hand surgery, many procedures can be performed under local anesthesia without the inconvenience or expense of having to go to another facility. In much the same way that dental surgery is usually done in the office without sedation, half of Dr. Gorman’s hand procedures are done this way. For those surgeries where the patient requests intravenous sedation, or when surgical complexity or longer procedure time requires general anesthesia, in-office surgery is not an option, and you may be scheduled for outpatient surgery at a same-day surgery center.
In-office surgery is performed wide-awake, without sedation, general anesthesia, or regional anesthetic nerve blocks. A local anesthetic is gently injected directly into the affected part of the wrist, hand, or fingers. A tourniquet may be used on the forearm initially for a few minutes, but it is often not needed at all. Patients are completely alert during the surgery and afterward may go home or return to work.
Advantages of in-office surgery include:
- You may drive yourself
- You don’t have to arrive several hours before your surgery
- You don’t have to get undressed
- No IV is required
- Local anesthetic provides pain relief for many hours after surgery
- A relaxed environment that produces less anxiety than a traditional operating room – you may bring your own music and headphones, or we will do our best to accommodate your music preference
- Less expense and less time away from work and other commitments
- Fasting after midnight is not required
- If you need a custom splint, this may be arranged immediately after your procedure – avoiding having to schedule another visit or go to another office
Is it comfortable?
The local anesthetic injections are not totally painless – much as it is not painless to have an immunization shot or to have blood drawn. However, patients report that, with Dr. Gorman’s use of a cold spray to numb the skin in combination with a very slow injection technique, they usually feel nothing more than the equivalent of an ice cube and pinch. Patients who have had skin lumps and bumps removed comfortably using local anesthetic will find this to be very similar, except that this anesthetic typically lasts for many hours. Half the patients are still numb the next morning and are usually able to avoid prescription pain medication.
Do I need to bring anyone with me?
Not usually. Most patients choose to drive themselves since the anesthetic is only injected locally and they are wide awake.
How long will the surgical procedure take?
Most procedures are 30-60 minutes in duration.
May I watch?
You will be lying down with your arm comfortably to the side on a hand table and must be still throughout the procedure. Dr. Gorman and his assistant sit on either side of your hand which is draped in a sterile field after a customary surgical prep, just like in an operating room. If you request, we would be happy to show you any pertinent pathology or anatomy if it won’t compromise the sterile field. If you would rather not see anything, you won’t have to.
What will I feel during the procedure?
For the first few minutes, you will feel the tourniquet pressure just below your elbow. During the actual procedure, you will feel touch in areas that are not numb and will still be able to move the hand on command. The surgical site will be completely numb to pain, but you may be aware of a slight tug or pressure.
What procedures can be done in-office?
Most soft tissue procedures and some minor fractures can generally be treated with local anesthesia and are, therefore, possible to do in-office. However, not all patients are candidates, especially those who struggle with anxiety or who have medical conditions which require sedation and monitored anesthesia. The best surgical venue is discussed individually with each patient before scheduling. Some of the procedures commonly done in our office include injections, laceration repair, revision fingertip amputation, trigger finger release, de Quervain’s release, foreign body removal (splinters, glass, etc), tendon repair, carpal tunnel release, removal of various lumps and bumps, minor joint surgeries, and treatment of many minor hand and finger fractures/dislocations.