Wide Awake Anesthesia Techniques in Hand Surgery
Summary
Wide awake local anaesthesia no tourniquet (WALANT) has emerged as a transformative approach in hand surgery, combining local infiltration of lidocaine and epinephrine to achieve both anaesthesia and haemostasis without the need for sedation or a pneumatic tourniquet. By permitting patients to remain conscious, this technique enables intraoperative assessment of active motion, immediate correction of tendon tension or implant impingement and real-time confirmation of repair integrity. It circumvents the risks associated with general or regional blocks, reduces perioperative resource demands and shortens total procedural time by eliminating preoperative sedation and postoperative recovery from systemic anaesthetic agents. Clinically, WALANT has been applied successfully across a spectrum of procedures—including carpal tunnel release, tendon reconstruction, fracture fixation and skin-flap repairs—demonstrating comparable functional outcomes, lower intraoperative discomfort and significant cost and workflow efficiencies. Its adoption has been particularly impactful in settings with limited anaesthetic support or during periods of resource constraint, illustrating its global relevance and potential to reshape standards of care in hand surgery.
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Wide Awake Anesthesia Techniques in Hand Surgery publication trend
The graph below shows the total number of articles in wide awake anesthesia techniques in hand surgery across all publications each year (not limited to Nature Index journals).
Technical terms
Wide-awake local anaesthesia no tourniquet (WALANT): A technique using local infiltration of lidocaine with epinephrine to provide anaesthesia and vasoconstriction without sedation or a pneumatic tourniquet.
Tumescent local anaesthesia: Large-volume injection of dilute local anaesthetic with vasoconstrictor to create widespread regional numbness and minimise bleeding.
Hypoperfusion: A controlled reduction in blood flow to the surgical site achieved via vasoconstriction.
Visual analogue scale (VAS): A patient-reported instrument for quantifying pain intensity along a continuous line or scale.
Quick Disabilities of Arm, Shoulder and Hand (QuickDASH): A shortened questionnaire assessing upper-limb disability and symptoms in functional tasks.
References
- How long to wait after local infiltration anaesthesia: systematic review. BJS Open (2023).
- A Randomized Controlled Trial Comparing Wide-Awake Local Anesthesia With No Tourniquet (WALANT) to General Anesthesia in Plating of Distal Radius Fractures With Pain and Anxiety Level Perception. Cureus (2021).
- Maintaining Access to Orthopaedic Surgery During Periods of Operating Room Resource Constraint: Expanded Use of Wide-Awake Surgery During the COVID-19 Pandemic. JAAOS Global Research and Reviews (2020).
- Optimization of Carpal Tunnel Syndrome Using WALANT Method. Journal of Clinical Medicine (2022).
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