Publications

Featured Publication of the Quarter

The following article has been selected as our featured publication of the quarter.

Published in Plastic and Reconstructive Surgery, this study, titled “Wide Awake vs Sedation in Carpal Tunnel Surgery: A Mixed-Methods Study on Patient Decision Making and Pain Perceptions,” examined why patients choose to undergo carpal tunnel release while fully awake with local anesthesia or in an operating room with sedation. Carpal tunnel release can be performed using two different anesthesia approaches. With wide-awake local anesthesia no tourniquet (WALANT), the hand and wrist are numbed with local anesthetic, and the patient remains awake throughout the procedure. In contrast, patients choosing sedation undergo surgery in a traditional operating room with monitored anesthesia care. The wide-awake approach can simplify the day of surgery by avoiding sedation and allowing patients to drive themselves home, while the operating room approach allows patients to be sedated and less aware of the procedure.

Thirty patients participated, with 15 choosing each approach. Patients completed questionnaires assessing pain, anxiety, depression, pain sensitivity, and pain-related coping, as well as interviews before and after surgery exploring their expectations, concerns, decision-making, and experiences. Patients who chose the two approaches were similar in their measured pain, psychological health, and pain-related coping characteristics, and both groups reported high satisfaction after surgery. However, interviews revealed clear differences in what influenced their decisions. Patients choosing wide-awake surgery often valued remaining aware and in control, avoiding anesthesia, having a shorter surgical experience, and being able to drive themselves home. In contrast, patients choosing sedation more often described anxiety about being awake, concerns about pain or movement during surgery, and previous stressful experiences with awake procedures.

These findings suggest that the choice between wide-awake surgery and sedation may depend less on a patient's pain tolerance or anxiety level and more on how they prefer to experience surgery. Some patients feel more comfortable remaining aware and involved, while others prefer to relinquish control and avoid awareness of the procedure. Understanding these preferences may help surgeons better tailor discussions about anesthesia options and support patients in choosing the approach that best aligns with their individual values and comfort.

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