ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN PROXIMAL INTERPHALANGEAL (PIP) JOINT FUSION
Patients can help you select the angle of PIP fusion during the surgery. You insert temporary K-wires and let them look at and move the fingers of the hand. They may ask you for a little more flexion or extension.
Patients get to see how much movement they will have once they get past the postoperative discomfort and stiffness.
Patients leave the operating room with realistic expectations of their final ability to move. They are motivated to work with the therapists to regain what they have seen moving at surgery.
All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.
WHERE TO INJECT THE LOCAL ANESTHETIC FOR PIP JOINT FUSION
Palmar injections: Inject 4 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 10 ml lido/epi:1 ml of 8.4% sodium bicarbonate) in the most proximal red injection point on the palmar side. Perform the most proximal dorsal injection next, and then inject 2 ml in the subcutaneous fat in the middle of each of the palmar proximal and middle phalanges. Dorsal injections: Inject 4 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 10 ml lido/epi:1 ml of 8.4% sodium bicarbonate) in the proximal red injection dot on the dorsal hand. Perform the two palmar injections next, and then inject 2 ml in the subcutaneous fat in the middle of each of the dorsal proximal and middle phalanges.
See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.
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Chapter 26 Arthroplasty of the Proximal Interphalangeal Joint
Chapter 28 Thumb Metacarpophalangeal Joint Fusion and Ulnar Collateral Ligament Repair
Chapter 27 Trapeziectomy With or Without Ligament Reconstruction for Thumb Basal Joint Arthritis
Chapter 3 Safe Epinephrine in the Finger Means No Tourniquet
Chapter 21 Trigger Finger
Chapter 35 Extensor Tendon Repair of the Finger
