Education

The Potential Benefits of Awake Surgery

Many patients prefer to avoid general anesthesia. Here is what awake surgery may offer, and what it cannot promise.

What we mean by awake

Awake surgery means the operation is done with local anesthesia, sometimes with light to moderate sedation, so you are not fully unconscious. It is a choice that suits some procedures and some patients.

Potential benefits

  • Avoiding a general anesthetic when it is not necessary. This avoids airway instrumentation and the effects of general anesthesia in suitable cases.
  • Safety record in liposuction. Large single-surgeon series of liposuction under tumescent local anesthesia, including one of 9,002 patients, have reported low complication rates. These are series from individual practices, not randomized trials.
  • Patient satisfaction. Systematic reviews of wide-awake local anesthesia in hand surgery report high satisfaction. This is a different surgical field, so it is supporting context only.
  • Lower blood loss from epinephrine. Dilute lidocaine with epinephrine constricts blood vessels in the treated tissue.
  • Active participation. You can communicate with the team and, in some operations, be positioned or move on request.

Limits and honest caveats

  • You may feel pressure, tugging or some discomfort even when the area is numb.
  • Longer, more extensive or more complex operations are often better suited to general anesthesia.
  • Local anesthetics carry their own risks, including toxicity if the dose is too high.
  • Sedation adds risks of its own, including the possible need for airway support.
  • Most of the published evidence for aesthetic surgery under local anesthesia is observational.

If an awake approach is not suitable, we will explain why and arrange general anesthesia.

Explore your options at a consultation

References

  1. Boeni R, Waechter-Gniadek PV. Safety of tumescent liposuction under local anesthesia in 9,002 consecutive patients. Dermatol Surg. 2021;47(5):e184-e187. PMID 33899793
  2. Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993. PMID 8234507
  3. Siu A, Wong RS, Ahmed Z, Talwar C, Nikkhah D. Patient satisfaction using wide-awake local anaesthesia no tourniquet (WALANT) in adults undergoing elective hand surgery: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2024;99:475-485. PMID 39476529
  4. Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake local anesthesia with no tourniquet: an updated review. Plast Reconstr Surg Glob Open. 2021;9(3):e3507. PMID 33786267
  5. Tang JB, Xing SG, Ayhan E, Hediger S, Huang S. Impact of wide-awake local anesthesia no tourniquet on departmental settings, cost, patient and surgeon satisfaction, and beyond. Hand Clin. 2019;35(1):29-34. PMID 30470328
  6. Conroy PH, O'Rourke J. Tumescent anaesthesia. Surgeon. 2013;11(4):210-221. PMID 23375489