1577 Roberts Drive, Suite 225, Jacksonville Beach, FL 32250
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Key Differentiator · Jacksonville Beach, FL

Surgery in the Office.
Wide Awake.
Home Within the Hour.

For eligible patients, Dr. Graham performs select hand procedures right here in the office using only local anesthesia — no IV, no sedation, no hospital, no anesthesiologist, no antibiotics. The procedure takes 15–20 minutes. Most patients are home within an hour.

15–20
minutes
procedure time
~1 hr
total office
visit
0
sedation, IV,
or antibiotics
Call (904) 241‑1204 See Which Procedures Qualify
What to Expect
💉
Local anesthetic only. John Tierney, PA-C administers the injection to numb the area — similar to a dental injection.
👀
You're awake. Some patients watch the procedure. Dr. Graham talks you through it.
⏱️
15–20 minutes for the procedure itself. You're in and out in roughly an hour total.
🏠
Home the same day. No recovery room, no anesthesia grogginess.
✅
Eligibility determined at consultation. Not every patient or procedure qualifies.
Affiliated With
Jacksonville Orthopaedic Institute Baptist Medical Center Beaches Jacksonville Beach Surgery Center
Home › In-Office Local Anesthesia Procedures

The Technique

A Different Kind of
Surgical Experience

Most people assume that surgery means a hospital, an IV, anesthesia, and a recovery room. For many hand procedures, that assumption is simply no longer necessary. A technique called WALANT — Wide Awake Local Anesthesia No Tourniquet — allows certain hand and finger surgeries to be performed safely and comfortably in an office setting, using only a local anesthetic to numb the area.

The result is an experience that surprises most patients. There's no fasting required the morning of the procedure. No one needs to drive you — though most patients prefer it. You're awake, comfortable, and able to have a conversation throughout. When it's over, you walk out. Many patients return to light activity the same day. And because the procedure is performed in a clean office environment without the systemic stress of anesthesia, no prophylactic antibiotics are required — eliminating that medication burden, its side effects, and one more thing to manage after surgery.

To Dr. Graham's knowledge, no other hand surgeon in Jacksonville currently offers this option for the range of procedures his practice performs in-office. It's not a corner-cutting approach — it's a patient-centered one, made possible by fellowship-level training and the right case selection.

For clinicians: WALANT uses epinephrine-containing lidocaine to achieve hemostasis, eliminating the need for a pneumatic tourniquet. This reduces patient discomfort, allows intraoperative assessment of tendon gliding and finger motion, and is well-supported in the hand surgery literature. Eligibility is determined by diagnosis, patient health, and procedural complexity.
Traditional Surgery vs. In-Office Procedure
❌ Traditional OR ✅ Dr. Graham's Office
Fast from midnight before surgery
Eat and drink normally
IV line placed before procedure
No IV — local injection only
General or sedation anesthesia
Awake and comfortable throughout
Hospital or surgery center
Office procedure room
Recovery room time required
Walk out when done
Need a driver; grogginess afterward
Most patients prefer a driver but it's not required
Pre-operative antibiotics required
No antibiotics needed — lower infection risk, no side effects
Surgery center / hospital fees
Office procedure — often lower total cost

Eligible Procedures

What Can Be Done in the Office

The following procedures are currently available as in-office local anesthesia procedures for eligible patients. Your consultation will confirm whether your specific case qualifies.

☝️
In-Office Available

Trigger Finger Release

Trigger finger occurs when the tendon sheath around a finger becomes inflamed, causing the finger to catch, pop, or lock when bending. When conservative treatment hasn't helped, surgical release of the constricted sheath resolves the problem reliably — and for eligible patients, this can be done right in the office.

What to expect: Local anesthetic numbs the finger. A small incision releases the constricted pulley. Procedure takes approximately 15 minutes. Most patients are home within the hour and can move the finger the same day.
🖐️
In-Office Available

Dupuytren's Percutaneous Fasciotomy

Dupuytren's contracture causes a cord of tissue to form in the palm, pulling one or more fingers into a bent position. Percutaneous fasciotomy — a needle technique — divides the cord through a tiny skin puncture. No incision. No stitches. Done under local anesthesia in the office.

What to expect: A needle is used to release the cord at multiple points under local anesthesia. Most patients see immediate improvement in finger extension. No wound care required. Recovery is typically faster than with open surgery.
🔵
In-Office Available

Mucous Cyst Excision

Mucous cysts are fluid-filled sacs that form near the fingernail, usually related to underlying arthritis in the end joint of the finger. When the cyst is causing discomfort, nail deformity, or drainage, surgical removal is the definitive treatment — and this is well-suited to office-based local anesthesia.

What to expect: The fingertip is numbed with local anesthetic. The cyst and any associated osteophytes are removed. A small dressing is applied. Procedure time is typically 15–20 minutes.
💧
In-Office Available

Ganglion Cyst Excision(Hand & Fingers)

Ganglion cysts are benign fluid-filled lumps that arise from joints or tendons. Hand and finger ganglion cysts — particularly those on the back of the hand or finger joints — are appropriate for in-office excision under local anesthesia for eligible patients.

Note: Volar (palm-side) wrist ganglion cysts require an operating room setting due to proximity to neurovascular structures. Dr. Graham will confirm the appropriate setting at your consultation.
🫱
In-Office Available

Hand Mass Excision

Benign masses of the hand — including lipomas, giant cell tumors of tendon sheath, and other soft tissue lesions — can often be excised in the office under local anesthesia. Dr. Graham evaluates each mass individually to confirm location, depth, and appropriate setting before recommending in-office removal.

What to expect: The hand is numbed with local anesthetic. The mass is carefully excised and sent for pathological review. A small dressing is applied and sutures are typically removed at a follow-up visit 10–14 days later.
🏥
Hospital or Surgery Center Setting

Some Cases Are Better Suited to the OR

Certain procedures — by nature of their complexity, exposure requirements, or implant needs — are performed at Baptist Beaches Hospital or an affiliated surgery center rather than in the office. These include:

  • → Carpal Tunnel Release — endoscopic technique requires OR equipment
  • → Volar wrist ganglion cysts — proximity to radial artery and nerves warrants OR setting
  • → Fractures requiring surgical repair — plate and screw fixation of the wrist, hand, or forearm
  • → Tendon and nerve repairs — lacerations and reconstructive cases requiring magnification and extended exposure

Note: Local anesthesia can still be used for many of these cases — the setting depends on procedure complexity, not technique. Dr. Graham uses local anesthesia extensively in the OR as well.

Your Visit

What Happens on Procedure Day

From the moment you arrive to the moment you leave, here's what the experience looks like.

1
You Arrive
Check in at the office. No fasting required. Eat and drink normally beforehand. You'll be called back promptly.
2
Local Anesthetic
John Tierney, PA-C, administers the local anesthetic injection to numb the area. Brief discomfort, then the hand is fully numb within a few minutes.
3
The Procedure
15–20 minutes. You're awake and comfortable. Dr. Graham talks through what he's doing. Some patients ask to watch — and can.
4
You Go Home
A dressing is applied. Brief recovery observation, then you're discharged. No recovery room. No grogginess. Total visit roughly one hour.

"Dr. Graham did an excellent job removing a ganglion cyst from my finger — and, amazingly, I was able to watch the surgery. He has a great sense of humor which helps keep patients calm. I love his sense of humor!!"

Linda Watson  ·  Ganglion Cyst Excision  ·  Verified Google Review ★ 5/5

Common Questions

Frequently Asked Questions

Wide-awake hand surgery — technically called WALANT (Wide Awake Local Anesthesia No Tourniquet) — uses only a local anesthetic injection to numb the hand or finger. There's no IV, no sedation, no hospital, and no anesthesiologist. You remain fully awake and comfortable throughout. The technique has become increasingly standard for appropriate hand procedures in the last decade, and is well-supported in the peer-reviewed hand surgery literature.
John Tierney, PA-C administers the local anesthetic — most patients compare the brief injection to a dental injection. Once the area is numb, you'll feel pressure but not pain. Most patients are genuinely surprised by how comfortable the experience is. Dr. Graham has a well-documented sense of humor and a knack for putting patients at ease — dozens of Google reviews mention it unprompted.
Because there's no sedation, you're not legally impaired. Most patients prefer to have a driver — particularly because the operated hand will be numb for a few hours after — but it is not required. This is one of the practical advantages of the office-based local anesthesia approach.
No. Because you're not receiving sedation or general anesthesia, there is no fasting requirement. Eat and drink normally the morning of your procedure. This is another significant practical advantage over traditional surgery center or hospital-based procedures.
Eligibility is determined at your consultation. Dr. Graham evaluates the diagnosis, its severity, your overall health, and the specific procedure to determine whether an in-office approach is appropriate. Most healthy patients with the right diagnosis are good candidates. Some medical conditions or procedure complexity may require a hospital or surgery center setting instead. If that's the case, Dr. Graham performs those procedures at Baptist Beaches Hospital and affiliated surgery centers.
Yes — and in some respects safer for the right patient. Eliminating general anesthesia or sedation removes the risks associated with those agents. Local anesthetic is highly targeted, and the absence of a tourniquet reduces postoperative pain. The technique is widely used by hand surgery specialists across the country and is backed by a growing body of evidence in the peer-reviewed literature. Case selection — knowing which patients and procedures are appropriate — is where training and experience matter most.
Setting up and running an in-office procedure room requires specific infrastructure, equipment, sterile technique protocols, and comfort with the WALANT technique itself — which is a distinct skill set from OR-based surgery. There are also economic considerations: hospital and surgery center cases are typically reimbursed at higher rates. Offering in-office procedures is a patient-centered choice, not the default. To Dr. Graham's knowledge, no other hand surgeon in Jacksonville currently offers this option for the range of procedures his practice performs in-office.

Next Steps

Is an In-Office Procedure
Right for You?

The best way to find out is a consultation with Dr. Graham. He'll review your diagnosis, examine the affected hand or finger, and discuss all of your options — including whether an in-office procedure is appropriate for your specific situation.

If an in-office approach isn't right for you, Dr. Graham performs the same procedures at Baptist Beaches Hospital and affiliated outpatient surgery centers, where a full surgical team and anesthesia are available.

  • You have trigger finger, Dupuytren's, a ganglion or mucous cyst, or a hand mass
  • Conservative treatment hasn't resolved the problem
  • You'd prefer to avoid general anesthesia or sedation
  • Your schedule makes a same-day, in-and-out procedure attractive
  • You want a fellowship-trained surgeon performing your procedure, supported by an experienced clinical team
Schedule a Consultation
Contact Dr. Graham's Office
R. David Graham, MD — hand and upper extremity surgeon at Jacksonville Orthopaedic Institute
R. David Graham, MD Hand & Upper Extremity Surgery · JOI Jacksonville Beach

Ask about availability for in-office procedures when you call. Clinic days are Tuesday, Wednesday, and Friday.

(904) 241‑1204
1577 Roberts Drive, Suite 225
Jacksonville Beach, FL 32250

Walk-in appointments are available through JOI Now on clinic days — no appointment needed for urgent hand and wrist concerns.

JOI Now Hours & Locations →

Dr. Graham is a member of the Jacksonville Orthopaedic Institute (JOI) and performs surgical cases at Baptist Beaches Hospital and affiliated outpatient surgery centers.

Clinical Note · For Clinicians & Curious Patients

The in-office local anesthesia technique used by Dr. Graham is commonly referred to in the hand surgery literature as WALANT: Wide Awake Local Anesthesia No Tourniquet. The technique was popularized by Dr. Donald Lalonde and colleagues and has been adopted by hand surgery practices worldwide over the past 15 years.

The key pharmacological principle is the use of epinephrine-containing lidocaine, which produces vasoconstriction sufficient to maintain a dry operative field without a pneumatic tourniquet. This eliminates tourniquet pain — historically one of the limiting factors in office-based hand surgery under local anesthesia — and allows the patient to actively move fingers during the procedure, enabling real-time assessment of tendon repair tension, trigger finger release adequacy, and implant fit.

Additional advantages include the elimination of prophylactic antibiotic requirements — infection rates for WALANT procedures in clean, office-based settings are comparable to OR-based procedures, and the antibiotic burden is removed entirely. This is a meaningful benefit for patients with antibiotic sensitivities or those on complex medication regimens.

Patient selection is essential. Not all diagnoses, anatomical presentations, or patient health profiles are appropriate for the office setting. Dr. Graham evaluates each patient individually and does not apply this technique universally.