Did you know we perform wide-awake hand surgery — hand surgery under local anesthesia alone — right in our Austin office? Popularized by Dr. Don Lalonde and others, this approach lets many routine hand procedures be done without general anesthesia or IV sedation. It’s routine in some places, but still uncommon here in Austin.
Why It Matters
Without general or IV anesthesia, the risk of a serious negative outcome drops to nearly zero — no risk of airway problems, stroke, heart attack, or blood clots from anesthesia. While these events are rare, they become more likely in older patients or those with conditions like hypertension, diabetes, or COPD. Removing anesthesia removes that risk entirely.
What to Expect
The procedure is performed in our office procedure room using the same sterile technique as a hospital or surgery center — just a smaller sterile field. We inject a dilute solution of lidocaine and epinephrine very slowly, so most patients only feel the fine needle at the very start. Then we wait — sometimes up to 20 minutes — for the epinephrine to fully constrict the blood vessels, during which you can read, check your phone, or take a restroom break. With a surgical headlight and magnifying loupes, we have the same tools we’d use in the hospital. Afterward, a soft bandage or splint is applied, and depending on the procedure you may even be able to drive yourself home — no grogginess or nausea from anesthesia.
Procedures We Perform Awake
- Carpal tunnel release
- Cubital tunnel and Guyon’s canal release
- Dupuytren’s contracture
- Trigger finger release
- Ganglion cyst and soft-tissue tumor removal
- Some tendon injuries — and the list keeps growing
Often Far Less Expensive
With high-deductible insurance, the true cost matters. A carpal tunnel release at a surgery center includes a surgeon fee, an anesthesia fee, and a facility fee — often $2,000–$3,000, much of which you may owe on a high-deductible plan (and only if those providers are in-network, which is increasingly not the case). In our office, you receive just the one surgeon’s fee — no anesthesia or facility fee — often one-third to one-half the cost. * As of August 2026, we no longer accept new insurance patients; wide-awake hand procedures are offered as a cash-pay service at a transparent price quoted in advance.
The Bottom Line
Wide-awake hand surgery is safer (no anesthesia risk), more convenient, and usually less expensive than the traditional surgery-center route. If you’re dealing with carpal tunnel, trigger finger, or another hand condition, contact us to see whether an in-office, wide-awake approach is right for you.