Being Wide Awake During Hand Surgery

Linda Tylutke of Avoca has a hands-on job roaming the aisles of Walmart to fill online orders, so when her hand began to lock up and prevent her from working, she turned to the Lehigh Valley Orthopedic Institute and Paul Sibley, DO, for help.

The condition Tylutke had is called “trigger finger,” when the tendon that controls the movement of a finger can’t move smoothly in its surrounding sheath. The finger may stick in a bent position, it can “catch” or “pop” when you try to move it, and it can hurt when you try to straighten it. After trying nonsurgical treatments, surgery can correct the mechanical issues causing trigger finger.

Tylutke chose to be wide awake during her surgery – an innovative option offered by Dr. Sibley to ensure the best possible results for his patients while also making the experience more comfortable and easier for them.

“It was awesome,” she says. “Dr. Sibley talked to me the whole time, and the nurses were great. I would definitely do it again.”

Wide-awake hand surgery using a local anesthetic has many advantages for patients, says Dr. Sibley, the chief of the Division of Orthopedic Surgery, Section of Hand Surgery. Patients don’t need to fast before surgery, they don’t have nausea or other complications that may come with general anesthesia, and they usually can drive themselves home, meaning a friend or family member does not need to be inconvenienced.

In addition, Dr. Sibley says, he can speak with the patient throughout the surgery, so he can test the repair by asking patients to move their hand. “We want to see the hand in motion before we are happy with the result,” he says.

Dr. Sibley also can explain the surgery and post-operative care to a wide-awake patient, rather than hoping his instructions are retained by a patient who may be foggy from general anesthesia.

“Some of my happiest patients are those who can see instantaneous results when we repair a tendon or fix a fracture,” Dr. Sibley says. “It is great to see the smile on their face when they say, ‘Well, I couldn’t do that before!’”

Tylutke, 62, recovered quickly and was pain-free and back to work within a few days. “I shop for people who place orders on the website,” she says. “I have to lift cases of water and soda sometimes, and pull a cart around with me. I use my hands all day, and before the surgery, my condition was preventing me from doing my job.”

Dr. Sibley does wide-awake surgery in about 25 percent of his procedures. He joined a group of hand surgeons from 15 countries in contributing to a textbook on different wide-awake procedures by a recognized expert, Donald Lalonde, MD, Professor of Surgery at Dalhousie University St. John, New Brunswick, Canada.

Dr. Sibley also provides his wide-awake surgery patients with an operating room light show and music of their choice, all designed to promote relaxation. “We try to make it as inviting an environment as possible,” he says.

Tylutke counts herself among Dr. Sibley’s most satisfied patients. “Anyone I know who has trigger finger or needs hand surgery,” she says, “I tell them to go see him.