Dr. Michael Dolan at West Tennessee Bone & Joint Clinic is pioneering a new kind of hand surgery that many in the medical community thought was impossible five years ago.

Instead of general anesthesia, Dr. Dolan injects a mixture of lidocaine and epinephrine into the wrist of patients to numb the area for surgery. Although dentists commonly use the injection, medical students were taught for decades not to inject epinephrine - or adrenaline - into the hand, Dr. Dolan said.

“It’s something totally new,” said Dr. Dolan, who is board certified in both general surgery and hand surgery.

Epinephrine constricts blood vessels, which allows the localized numbing effects of lidocaine to last longer, but the medical community feared for a long time that it would restrict blood flow to the extent of killing the hand. That has been proven wrong, Dr. Dolan said, and wide-awake hand surgery is a remarkably easier experience for patients.

Patients do not have to abstain from eating or drinking. They keep their street clothes on and receive a single shot in the wrist, which is less painful than the IV required for general anesthesia. They then sit painlessly through the procedure while Dr. Dolan carries on a conversation with them.

“Then they stand up, walk out and go home,” Dr. Dolan said.

It is not uncommon for patients to spend a night - or more - recovering in the hospital after general anesthesia. The required prep work also can require them to arrive at the surgery center hours in advance.

General anesthesia is also a vascular stressor, Dr. Dolan said, and patients often feel as if they have just run a race. With wide-awake surgery, the numbness of the lidocaine wears off after about six hours.

Patients are injected with Marcaine after the procedure, which prevents them from experiencing pain for another 24 hours. By that time, the pain is gentle enough that it can be treated with ibuprofen, Dr. Dolan said.

Some patients have had the wide-awake procedure on their lunch break and returned to work for the rest of the day, Dr. Dolan said. And, because the recovery period is less painful, patients often don’t need the regimen of painkillers that can become addictive and that are associated with the aftermath of traditional surgery, he added.

“Many people who will go through the wide-awake surgery without a single narcotic.”

General anesthesia also carries the risk of complications that could be fatal. As a result, wide-awake surgery is safer. It’s also cheaper for patients and faster for doctors to perform, he said.

“It allows us to get patients in and out of the operation theater much quicker.”

Dr. Dolan has performed wide-awake surgery on patients from ages 12 to 95, though, typically on patients with carpal tunnel syndrome or trigger finger. He also uses the procedure to remove a benign cyst or to repair a hand after a laceration or other trauma.

In 2010, the first year he performed the technique, 10 percent of his carpal tunnel surgeries were wide-awake. The number grew to 30 percent in 2011 and 50 percent in 2012. This year, 75 percent of his carpal tunnel surgeries have been wide-awake.

“We’ve all just been wowed about it because the patients just do so well,” Dr. Dolan said.

Featured Doctor

Michael Dolan, M.D. Hand Surgery

Dr. Michael Dolan is board certified in both hand and general surgery. A graduate of Baylor University, Dr. Dolan earned his medical degree at St. George’s University School of Medicine.

His surgical residency was at the University of Mississippi Medical Center in Jackson, Mississippi, in the trauma unit. His hand surgery residency was at University of Texas Southwestern in Dallas.

Dr. Dolan spent three years practicing at the Hand Specialty Center of Tennessee, a clinic he started in Selmer where half his practice was trauma cases and the other half elective surgery.

As a hand surgeon, Dr. Dolan treats many problems of the lower arm, including nerve problems in the elbow and hand; congenital problems, such as removing an extra finger; soft tissue work, such as skin grafting; fractures in the forearm, wrist and hand; arthritic conditions of the hand, fingers, wrist and thumb; and torn ligaments in the wrist. Often, his treatment requires microsurgery to reattach tiny vessels.