WALANT (Wide Awake Local Anesthesia No Tourniquet)
Wide Awake Local Anesthesia No Tourniquet (WALANT) is a technique for hand and wrist surgery that uses local anesthesia. It offers many advantages over standard procedures including no general anesthesia, better surgical outcomes and lower costs. With the appropriate operation, WALANT is a better solution that costs less.
WALANT is a new type of local anesthesia that improves various hand and wrist surgery procedures. Until recently, certain hand and wrist surgeries were performed using a tourniquet to control blood to improve the surgeon’s visibility of the operated area. Tourniquets, however, are uncomfortable and unpleasant for patients. In the past, this discomfort was reduced by sedating patients with general anesthetics. (General anesthetics are used to cause a patient to lose consciousness during surgery.)
WALANT eliminates the need for tourniquets and general anesthesia (sedation) by using two medications administered locally for a safe, painless surgery. Lidocaine blocks pain, and epinephrine stops bleeding. Epinephrine acts as a vasoconstrictor to control bleeding, which is why the use of tourniquets can be eliminated during the procedure. While not every hand and wrist surgery can be performed with WALANT, there are many that qualify, some of which include:
- Nerve compression
- Tendon disorders or repairs
- Carpal tunnel release
- Trigger finger release
- Finger sensory block
- Soft-tissue Finger lesions
- PIP fusion s
- Thumb MCP fusions
- Collateral ligament tears of the MCP joint
- Oupuytren contractures
- Flexor tendon repairs
- Trapeziectomy or Bennett fracture
- Metacarpal fractures
- Ligament repairs
- Fracture fixation
- Arthritic conditions
- Mass removal
The patient advantages of using WALANT are:
- No cost/ time lost for preoperative testing for sedation, since there is no general sedation.
- Less expensive procedure. A high percentage of surgical costs come from the price of general sedation. Since there is no sedation, the procedure is not as costly.
- Less time at the hospital or surgery center for the procedure as there is no recovery time from the surgical procedure.
- The use of general sedation requires that someone needs to be with the patient when they are finished with the operation to take them home. Since there is no general sedation, the patient does not need someone there.
- If desired, patients can see and feel repaired structures working during the surgery after a loss of function, which helps motivate the patient in post-operative therapy and recovery.
- No need for a tourniquet.
- No need to fast or change medication schedules which is particularly helpful for diabetics.
- Only one nurse is required to assist the surgeon when performing most simple hand operations such as carpal tunnel release. This significantly increases efficiency, reduces costs, and increases productivity for the surgeon.
- Increased safety. The elimination of general sedation increases safety. No research shows that WALANT is unsafe in any way. Overall, WALANT provides a cheaper and easier surgical experience, making it an effective choice.
While WALANT offers many advantages, there are a few minor disadvantages. The injection of local anesthesia can be slightly uncomfortable for approximately the first 10 to 15 seconds much like a bee sting or like that of a dental injection. Additionally, some patients may not enjoy being awake during their procedure. The only other disadvantage is that it is only offered for select hand and wrist surgical procedures.
Contact your Florida Orthopaedic Institute hand and wrist surgeon to find out if your surgery can be done with WALANT.