Response to the letter to the editor of P. Mahapatra

We thank the colleagues for their additions to our article. Intentionally, in the discussions section we focused on those parameters that have been measured in the study [1]. Indeed, wide-awake surgery has several interesting aspects. The term “wide-awake” implies the absence of a premedication. This absolves the surgeon from his responsibility for the patient after his discharge after the operation. And it allows the patient to be discharged directly post-op instead of waiting for the anesthesia fading away. The latter was a main factor in the patients’ satisfaction when we asked those, who experienced both, axillary plexus anesthesia and local anesthetics, which type of anesthesia they prefer. However, the patients’ satisfaction was not explicitly measured in our study. Hereof, we refer to the article of Koegst et al. of the year 2011 in this journal. Beside a higher level of patients’ satisfaction, the early discharge opens new resources for new patients in the recovery area. And, new resources arise, since there is no need for an anesthesia team, while wide-awake surgery is performed.

If or if not a follow-up is regularly arranged after a carpal tunnel release is up to the surgeon, on one hand. On the other hand, for the vast majority of patients in Germany, this is up to factors that do not have anything to do with medicine. In our institution we see all patients the next day to make sure, that all fingers are fully moved and to check sensibility. The data of the colleagues at least seem to qualify the need for a strict follow-up arrangement for this procedure.

Having introduced wide-awake surgery for some procedures and thereby improving the operative throughput, the bottleneck operating room capacity widens and waiting lists shorten a bit. However, the most important advantage is probably, that the patients can actively move their fingers, which makes wide-awake surgery an interesting approach for tenolyses or tendon transfers.

• References

• 1 Löw S, Herold D, Eingartner C. Der „Wide-Awake Apporoach“ – Effizienz und Patientensicherheit bei der Karpaldachspaltung. Handchir Mikrochir Plast Chir 2013; 45: 271-274