WALANT

Revolutionizing Hand Surgery: Awake, Comfortable, and Tourniquet-Free with WALANT

Wide Awake Local Anesthesia No Tourniquet (WALANT) surgery is a modern adaptation of well-established techniques to the world of hand surgery. It allows surgeons to perform procedures the hand or wrist using only local anesthesia, without the need for sedation or a tourniquet. Local anesthesia is simply what dentists use to control pain while addressing many issues about the mouth, for example teeth cavities, on a daily basis. The twist is adapting patients who are wide awake in combination with no use of a tourniquet during surgery.

A tourniquet is how hand surgeons control bleeding during an operation as visualizing the problem is critical to being able to fix the problem. This technique has revolutionized outpatient surgery by offering patients a safer, more cost-effective, and more convenient alternative to traditional methods.

The roots of WALANT can be traced back to the early 20th century, when Dr. August Bier explored local anesthetics for limb surgeries. However, it was Dr. Donald Lalonde, a Canadian plastic surgeon, who popularized and refined the WALANT technique in the early 2000s. By combining lidocaine, a medication for anesthesia, with epinephrine, to reduce bleeding and prolong effects, surgeons found that they could perform intricate procedures with the patient fully awake, eliminating the risks associated with general anesthesia and tourniquet discomfort.

This technique also allows for real-time assessment of hand function during surgery, as patients continue to have the ability to move their fingers. This is particularly advantageous in tendon repairs and other dynamic procedures where intraoperative assessment can guide better outcomes.

Additionally, because no sedation is required, patients avoid fasting and the side effects of anesthesia, making the whole experience more comfortable and much safer. For patients, this translates to quicker recovery, fewer complications, and the ability to return home shortly after surgery.

The technique has gained worldwide recognition and continues to expand into new areas of hand surgery. WALANT represents a significant leap forward in minimally invasive, patient friendly surgical care and as more surgeons adopt WALANT, it promises to redefine the patient experience.