Wide Awake Local Anesthesia No Tourniquet (WALANT)

Wide Awake Hand Surgery is a new technique of performing certain surgeries without the need of general anesthetics.  Traditionally, pain and bleeding during hand surgery have been controlled using some form of general anesthesia and a tourniquet wrapped around the arm. While these methods have been and continue to be effective, we have been able to exchange the tourniquet and general anesthesia for two medicines, lidocaine and epinephrine.  Lidocaine is a local anesthetic used to block pain (similar to a dentist’s Novocain) and epinephrine is a medicine that is used to control bleeding.  With specialized techniques for introducing the medicine to the surgical area, the injection is nearly painless.  In addition, there is no need for insertion of an IV.

This alternative to anesthesia has been proven a safe and effective means for performing hand surgery.  The benefits of WALANT surgery include:

  • Patients who were previously not candidates for surgery due to other medical problems can now have their surgery. By eliminating the need for general anesthesia the risks have been significantly decreased—opening the door for those previously deemed “too sick” for surgery.
  • Patients feel normal immediately after surgery. Unlike general anesthesia, WALANT eliminates uncomfortable side effects such as nausea or prolonged sedation.
  • The surgical process is shortened. Preoperative anesthesia planning and a postoperative recovery are eliminated from the surgical process.
  • Fasting is not usually required. Patients can eat or drink something light the morning of surgery.
  • Medications do not need to be stopped. Lidocaine and epinephrine do not interfere with most medications that are commonly used, including blood thinners.
  • Patients save time and money. Preoperative blood work and medical tests are rarely needed. In addition, the fees for anesthesia are eliminated.
  • Patients can communicate with their surgeon during and after surgery. Patients know what is going on during surgery and they receive post-operative instructions immediately after their surgery is over. Patients are also able to demonstrate limb function during the procedure per the surgeon’s request, allowing for immediate evaluation of the treatment. 

WALANT is available for many surgical procedures, including carpal tunnel, trigger finger, de Quervains’ release, tendon repairs, hand and finger fractures, mass excisions, and the treatment of some arthritic conditions of the hand.