Eliminating the need for a tourniquet (see Chapter 3 and injecting local anesthetic so that it hardly hurts the patient at all (see Chapter 5) removes the two main reasons that patients need sedation for most hand operations. Once patients truly understand the added conveniences of WALANT (see Chapter 2), most will no longer want sedation for hand surgery, any more than they would want sedation to have a tooth filled at the dentist′s.

Eliminating sedation also means that you can easily perform many hand surgery cases in minor procedure rooms with field sterility in the same way that you remove nevi and small skin cancers (see Chapter 10).

It is primarily tradition that stands in the way of eliminating the tourniquet, sedation, and the need for main operating room full sterility (see Chapter 12) for hand surgery. Once all concerned have a better understanding that WALANT increases patient safety and convenience while decreasing costs and unnecessary production of garbage, more patients will benefit.

Patients ultimately pay the whole cost of their health care, either directly with cash or indirectly through public taxes or private insurance plan payments. Ultimately, the patient saves all of the costs of sedation or general anesthesia listed here under hospital costs.1

Patients spend less time at the hospital because there is no sedation and because they do not need to undress and be transferred into the main operating room. They roll up their sleeve, have the surgery, then get up and go home right after the operation. Less time at the hospital means less time away from work, lower child care costs, fewer parking fees, and other incidental expenses associated with an overnight or prolonged hospital stay.

The purpose of most preoperative testing is to increase the safety of sedation rather than to confirm the patient′s readiness for surgery. Patients therefore do not incur the cost of time away from work or getting a babysitter while they go for the preoperative assessment or testing required for sedation, because this will not be needed with WALANT.

Many facilities require patients to have someone stay with them the evening and/or night of sedation. There are no “babysitter” requirements for patients who have wide awake surgery. Patients can go home, look after their children, and resume their normal activities without having someone accompany them to look after them as they recover from sedation.

Surgeons give patients intraoperative education that may well decrease their risk of complications and reoperation and therefore decrease the costs associated with these events.

It is possible to see a patient in consultation and operate on him or her the same day, because there is little or no preoperative workup required for pure local anesthesia. This is a significant cost savings for patients who have to travel long distances to the surgeon′s facility.2