Novel Use of the Wide-Awake Local Anesthesia No Tourniquet Technique for Release of Spastic Upper Limbs.

Wide-awake local anesthesia no tourniquet procedures allow the patient to remain conscious and cooperative during surgery, allowing intraoperative assessments of hand function. This is useful in spastic hand surgeries, allowing an instant assessment of the muscle releases and residual power, thus guiding an optimal balance with the best possible functional outcomes. We describe the novel use of wide-awake, local anesthesia, no tourniquet surgery in spastic upper-limb surgery in forearm flexor-pronator release, thumb-in-palm and intrinsic-plus deformity correction, and elbow flexor release.