“Wide Awake Hand Surgery” is a small illustrated technical book written by Donald Lalonde, who is a professor
at Dalhousie Medical School in New Brunswick, Canada.
Dr. Lalonde has extensive expertise in hand surgery, with many years of experience
using local anesthetics with epinephrine in surgery.
This book is written in a simple, easy-to-understand manner; as the author states
in the preface, it has recipes similar to those of a cook-book. The abundant illustrations
and descriptions provide a sufficient general understanding of how to conduct anesthesia
for hand surgery. The book buyer can register and can obtain an e-book and many video
clips online. Each video clip includes procedures and communications between patients
and Dr. Lalonde. Communication skills are also very useful for beginning hand surgeons.
Epinephrine was discovered by Napoleon Cybulski in 1895, and was first used for ophthalmic
surgery. So far, it has been believed that epinephrine should be avoided because of
necrosis caused by vasoconstriction.
It is logical expectation, but it has not been supported by practical evidence. Dr.
Lalonde claimed that pervious expectations is wrong. He has investigated many previous
reports on the use of epinephrine as a local anesthetic in hand surgery, and ultimately
came to the following conclusion about its safety: Epinephrine does not lead to necrotic
changes, and is beneficial for hand surgery because it provides a bloodless field
without a tourniquet. Chapters 2 and 3 contain the supporting data and evidence for
this proposal. Thus, evidence-based medicine can help put our practice on solid foundations.
This book describes how to use epinephrine for hand surgery and what to expect when
it is used. Most of the chapters are written well, with defined objectives and clearly
presented illustrations, allowing the reader to obtain the maximum benefit in a minimal
amount of time.
Another advantage of his technique is that the patient is awakened during surgery.
This is unfamiliar for some surgeons, so Dr. Lalonde provides a thorough explanation
of patient awakening in hand surgery.
I would like to recommend this book for hand surgeons who want to perform surgery
more simply and easily.
