Wide-awake local anesthesia no tourniquet surgery has emerged as a preferred approach in hand surgery as a result of its efficacy, cost-effectiveness, and patient satisfaction. The approach changes communication dynamics in the operating room.

"Introducing an awake patient requires a 180-degree change in the entire dynamic of [operating room] conversation," wrote lead study author Jean Paul Brutus, MD, and colleagues. "With awake surgery, the patient is now the most important conversationalist in the room," they added.

The investigators, with more than 65 years of combined awake hand surgery experience, presented a comprehensive communication framework covering the entire perioperative process.

For initial patient contact, the study authors noted: "[A]lmost completely avoid the words of an answering machine" and instead employ "a friendly human voice (ie, administrator/secretary) on the surgeon's end of the line." The telephone conversation can begin with: "Hello, this is Dr. X's office, how are you doing today?"

In the holding area, rather than directly asking patients to state their name and birth date—which "has the undesirable effect of possibly making the patient worry that we do not really know who they are"—the investigators suggested addressing patients by name while reviewing consent forms. For example: "Mr. Smith, could you please help me make sure I have the correct age and phone number for you?"

The investigators also recommended reframing preoperative anxiety by asking "Are you excited about having this done?" instead of asking if patients are nervous, which "makes them focus on their fear."

During local anesthesia administration, surgeons should avoid the word "needle" and use alternatives like "you will feel a little pinch or pinprick." The investigators cautioned against making false guarantees about pain since "these are promises you cannot keep."

"Even if patients prefer not to feel pain, they prefer the truth and deserve your honesty," they wrote.

For operating rooms that handle both sedated and local anesthesia cases, a sign stating: "Awake patient; Watch what you say!" should be posted to alert staff who might otherwise enter assuming patients are unconscious.

The investigators introduced the concept of "operating table side manners" and emphasized avoiding silence during surgery, which "can be eerie and encourage the patient's mind to imagine terrible things." Instead, surgical teams should use operating time to educate patients about postoperative care.

Specific recommendations included:

• Replace surgical instrument names with numbers: "Blade, scalpel, or knife" becomes "15" and "needle" becomes "32 or 30."

• Substitute "fluid" for "bleeding" to reduce patient anxiety.

• Eliminate exclamations like "oops," "uh-oh," or "oh my God!"

• Address team members by name before delivering messages.

The investigators concluded that "words matter and will affect a wide-awake patient" and that surgical teams "need to focus the conversation on the patient to improve their experience."

A comprehensive summary table in the article provided specific recommendations for terms to avoid and preferred alternatives across all stages of the surgical experience.

The authors declared having no competing interests.

Source: PRS Global Open