Nicholas Genovese, M.D. · In-office procedures
In-office procedure room setup (local / WALANT)
- Position and table
- seated or supine, hand table with a sterile half sheet
- Tourniquet
- 18" arm tourniquet, set up, plugged in and turned on before the case
- Anesthesia
- standard local, 10 mL of 50/50 1% lidocaine with epinephrine and 0.25% bupivacaine; without epinephrine if the patient has Raynaud's. Pull the medication bottles before the case for review. 10 mL syringe, 25 G needle
- Equipment and implants
- Standing sterile instrument tray: Senn retractors x 2, small Ragnell retractors x 2, skin hooks x 2, toothed Adson forceps, Littler or curved tenotomy scissors, 1 mosquito/hemostat, small curette, needle driver, #3 knife handle
- Opened at the time of the procedure: #15 blade, 4-0 or 5-0 nylon, sterile marking pen, chlorhexidine or povidone-iodine prep, 2–4 sterile towels
- Dressing and splint
- Adaptic or Xeroform, 4x4 gauze, 1" or 2" Coban
- Notes
- Applies to minor procedures in the office procedure room (for example trigger finger, de Quervain, small mass and cyst excisions). Room time is set by the schedule.
Standard setup for every case
Table: almost every procedure can be done on the pre-op stretcher with a hand table attached.
Cautery: bipolar electrocautery for every case.
Tourniquet: local or MAC cases often use an Esmarch tourniquet, or a Tourni-cot for a finger. Cases under a nerve block use an 18" arm tourniquet.
Standard local: 10 mL total, 50/50 mix of 1% lidocaine with epinephrine and 0.25% bupivacaine (Marcaine) with epinephrine. Use local without epinephrine if the patient has a history of Raynaud's, and for the finger fracture and fusion cases marked "without epinephrine".
Base dressing on every wound: Adaptic, wet 4x4, dry 4x4, then the case-specific outer wrap or splint on the card.
Have available: hand tray, tourniquet, bipolar; Coban, Tegaderm, ACE wrap, Steri-Strips, benzoin or Mastisol; sutures 4-0 nylon, 4-0 Vicryl, 4-0 Monocryl, 3-0 Vicryl, 3-0 Monocryl.
Post-op appointments: most first post-op visits are at 2 weeks unless the card or the booking says otherwise. Book the first hand therapy visit at the same time as the post-op surgeon or PA visit.
Abbreviations: CRPP = closed reduction percutaneous pinning; ORPP = open reduction percutaneous pinning; ORIF = open reduction internal fixation; MAC = monitored anesthesia care; WALANT = wide-awake local anesthesia, no tourniquet.
Preference cards are a reference for operating room teams. The surgeon confirms the final plan, implants and anesthesia for each patient at booking. Questions: call the office at (858) 560-0242.
All preference cards