Some doctors are operating on hands in a new way: with the patient wide awake. It eliminates the risks and side effects of general anesthesia. But the technique has been slow to catch on in the United States because of a decades-old myth about the dangers of injecting adrenaline into hands. From the Arizona Science Desk, Melissa Sevigny reports on how that’s starting to change.
A lot of people wouldn’t want to watch a doctor cut open their hand. But for Rita Stuckey of Prescott, getting to watch her own operation for arthritis was actually pretty great.
“I watched him make the incision, I watched him drill, I watched him pull out big pieces of bone,” she says. “I didn’t feel one even twinge of pain, and yet I got to see clearly how it was done.”
“Wide Awake Hand Surgery” requires a shot of adrenaline to reduce bleeding and give the doctor a clear view. It’s a new idea for doctors who were taught for decades never to inject adrenaline into hands. Canadian surgeon Don Lalonde helped prove that fear is unfounded.
It’s based on a myth kept alive for half a century by outdated textbooks and memorable rhymes, like this one: “Never put adrenaline into fingers, nose, penis and toes.”
“You’d have to be the world’s biggest dummy to not remember,” Lalonde says.
The myth came from the 1940s, when a few dozen people lost fingers to gangrene after surgery. Adrenaline took the blame. But it was just an innocent bystander. Lalonde says the real culprit was bad procaine, the only anesthetic available at the time.
“The reason they didn’t know about this is they didn’t have expiry dates before 1972, so in the old days you could have a bottle of procaine sitting on your shelf for 10 years,” he explains.
Because of this misconception, doctors used tourniquets instead of adrenaline to reduce bleeding. Tourniquets are so painful patients have to be asleep. But that’s starting to change. Flagstaff surgeon John Durham was the first to bring wide awake hand surgery to northern Arizona.
“It’s been a game-changer for me in terms of treating my patients,” Durham says. “There’s a newness to it, a freshness to the technique, that also offers a lot of benefits.”
The procedure is less expensive for one thing. Patients don’t have to fast before their surgery, and they can leave the hospital right away, without feeling groggy or nauseous. Durham says he can even have them to test the repair work on the spot, to make sure everything went well.
“They are there participating through the whole thing,” Durham says. “There’s no missing time, they know what happened, they know something was done, and many times got to see exactly what was done. I think that’s beneficial to them. I think they’re recovering better with that knowledge of what happened to them.”
Rita Stuckey, who just had Wide Awake Hand Surgery, agrees. “It really is like going to the dentist—zip zop, you’re in, they do the stuff, you’re out, you go home, you eat lunch, you do whatever you want to do,” she says.
Stuckey says she knows change happens slowly in the medical world. But there’s reason to think the old myth about adrenaline’s dangers really is gone for good. Last year, the American Association for Hand Surgery held its annual conference in Scottsdale. It included, for the first time ever in the United States, an all-day course on wide-awake hand surgery.