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Review
. 2021 Mar 26;9(3):e3507.
doi: 10.1097/GOX.0000000000003507. eCollection 2021 Mar.

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Joey S Kurtzman  1 , Jennifer I Etcheson  1 , Steven M Koehler  1
Affiliations
Review

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Joey S Kurtzman et al. Plast Reconstr Surg Glob Open. .

Abstract

The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT.

Methods: A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety.

Results: The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates.

Conclusions: The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.

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Conflict of interest statement

Disclosure: Dr. Koehler is a committee member of the American Society for Surgery of the Hand (ASSH), a paid consultant and speaker for Integra LifeSciences, Inc., a paid consultant for Tissium, Inc., a stockholder and member of the medical advisory board for Reactiv, Inc., a member of the advisory board for Androes, LLC, and a speaker for TriMed, Inc. The other authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Dorsal metacarpal artery perforator (Quaba) flap via WALANT.
Fig. 2.
Fig. 2.
Clavicle fixation with WALANT. A, Outline of clavicle with preoperative injection sites marked with X. B, Intraoperative radiograph demonstrating clavicle fixation via WALANT (courtesy of Dr. Jeffrey Gelfand).
Fig. 3.
Fig. 3.
Propeller flap via WALANT.
Fig. 4.
Fig. 4.
Collection of all disposable materials from 1 CTR procedure.
Fig. 5.
Fig. 5.
Following restrictions on surgical procedures during the COVID-19 pandemic, we have since performed 72 cases during a 3-month “lockdown” under WALANT. The office-based minor procedure room setup and equipment are depicted here.
Fig. 6.
Fig. 6.
Median nerve reconstruction (A) with sural nerve autograft (B).
Fig. 7.
Fig. 7.
Pediatric both bone forearm fracture fixation.
Fig. 8.
Fig. 8.
Zone 4 extensor tendon laceration repair.
Fig. 9.
Fig. 9.
Finger amputation.
See this image and copyright information in PMC

References

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