Wide-Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery

Michael J. Fish, H Brent Bamberger, Michael J. Fish, H Brent Bamberger

Excerpt

Wide-awake Local Anesthesia No Tourniquet (WALANT) is a surgical technique that relies on local anesthetic and hemostatic agents to provide conditions suitable for hand surgery without sedation and tourniquet. The exclusion of sedation makes it possible to perform more procedures in an ambulatory setting rather than rely on general anesthesia only in the operating room. The use of WALANT leads to decreased cost and enhanced patient safety.

Canadian plastic hand surgeon Dr. Lalonde first implemented WALANT to decrease wait times for surgery. He formally proposed the concept in 2005 and has since internationalized it.

Conflict of interest statement

Disclosure: Michael Fish declares no relevant financial relationships with ineligible companies.

Disclosure: H Brent Bamberger declares no relevant financial relationships with ineligible companies.

Copyright © 2023, StatPearls Publishing LLC.

References

    1. Huang YC, Hsu CJ, Renn JH, Lin KC, Yang SW, Tarng YW, Chang WN, Chen CY. WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet. J Orthop Surg Res. 2018 Aug 06;13(1):195.
    1. Tan E, Bamberger HB, Saucedo J. Incorporating Office-Based Surgery Into Your Practice With WALANT. J Hand Surg Am. 2020 Oct;45(10):977-981.
    1. Tahir M, Chaudhry EA, Zaffar Z, Anwar K, Mamoon MAH, Ahmad M, Jamali AR, Mehboob G. Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique: A randomized control trial of a cost-effective and resource-friendly procedure. Bone Joint Res. 2020 Jul;9(7):429-439.
    1. Hobday D, Welman T, O'Neill N, Pahal GS. A protocol for wide awake local anaesthetic no tourniquet (WALANT) hand surgery in the context of the coronavirus disease 2019 (COVID-19) pandemic. Surgeon. 2020 Dec;18(6):e67-e71.
    1. Lalonde DH, Wong A. Dosage of local anesthesia in wide awake hand surgery. J Hand Surg Am. 2013 Oct;38(10):2025-8.
    1. Maliha SG, Cohen O, Jacoby A, Sharma S. A Cost and Efficiency Analysis of the WALANT Technique for the Management of Trigger Finger in a Procedure Room of a Major City Hospital. Plast Reconstr Surg Glob Open. 2019 Nov;7(11):e2509.
    1. Far-Riera AM, Pérez-Uribarri C, Sánchez Jiménez M, Esteras Serrano MJ, Rapariz González JM, Ruiz Hernández IM. Prospective study on the application of a WALANT circuit for surgery of tunnel carpal syndrome and trigger finger. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019 Nov-Dec;63(6):400-407.
    1. Garmon EH, Huecker MR. StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2022. Sep 9, Topical, Local, and Regional Anesthesia and Anesthetics.
    1. Lanza F, Beretz A, Stierlé A, Hanau D, Kubina M, Cazenave JP. Epinephrine potentiates human platelet activation but is not an aggregating agent. Am J Physiol. 1988 Dec;255(6 Pt 2):H1276-88.
    1. Spalding A, Vaitkevicius H, Dill S, MacKenzie S, Schmaier A, Lockette W. Mechanism of epinephrine-induced platelet aggregation. Hypertension. 1998 Feb;31(2):603-7.
    1. Lalonde DH. Latest Advances in Wide Awake Hand Surgery. Hand Clin. 2019 Feb;35(1):1-6.
    1. Pires Neto PJ, Ribak S, Sardenberg T. Wide Awake Hand Surgery Under Local Anesthesia No Tourniquet in South America. Hand Clin. 2019 Feb;35(1):51-58.
    1. Rhee PC, Fischer MM, Rhee LS, McMillan H, Johnson AE. Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures. J Hand Surg Am. 2017 Mar;42(3):e139-e147.
    1. Thakkar M, Bednarz B. Should WALANT surgery be included in the training curriculum? J Plast Reconstr Aesthet Surg. 2020 Aug;73(8):1575-1592.
    1. Duquette S, Nosrati N, Cohen A, Munshi I, Tholpady S. Decreased wait times after institution of office-based hand surgery in a Veterans Administration setting. JAMA Surg. 2015 Feb;150(2):182-3.
    1. Thompson Orfield NJ, Badger AE, Tegge AN, Davoodi M, Perez MA, Apel PJ. Modeled Wide-Awake, Local-Anesthetic, No-Tourniquet Surgical Procedures Do Not Impair Driving Fitness: An Experimental On-Road Noninferiority Study. J Bone Joint Surg Am. 2020 Sep 16;102(18):1616-1622.
    1. Hutchinson DT, McClinton MA. Upper extremity tourniquet tolerance. J Hand Surg Am. 1993 Mar;18(2):206-10.
    1. Ki Lee S, Gul Kim S, Sik Choy W. A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet. Orthop Traumatol Surg Res. 2020 Dec;106(8):1645-1651.
    1. Leblanc MR, Lalonde J, Lalonde DH. A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada. Hand (N Y) 2007 Dec;2(4):173-8.
    1. Nodwell T, Lalonde D. How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective, randomized, blinded study: The Dalhousie project experimental phase. Can J Plast Surg. 2003 Winter;11(4):187-90.
    1. Zhao C, Amadio PC, Tanaka T, Kutsumi K, Tsubone T, Zobitz ME, An KN. Effect of gap size on gliding resistance after flexor tendon repair. J Bone Joint Surg Am. 2004 Nov;86(11):2482-8.
    1. Chauhan A, Palmer BA, Merrell GA. Flexor tendon repairs: techniques, eponyms, and evidence. J Hand Surg Am. 2014 Sep;39(9):1846-53.
    1. Lalonde DH, Kozin S. Tendon disorders of the hand. Plast Reconstr Surg. 2011 Jul;128(1):1e-14e.
    1. Miller A, Kim N, Ilyas AM. Prospective Evaluation of Opioid Consumption Following Hand Surgery Performed Wide Awake Versus With Sedation. Hand (N Y) 2017 Nov;12(6):606-609.
    1. Frank SG, Lalonde DH. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg. 2012 Summer;20(2):71-3.
    1. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001 Jul;108(1):114-24.
    1. Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007 Jan;119(1):260-266.
    1. Cunnington C, McDonald JE, Singh RK. Epinephrine-induced myocardial infarction in severe anaphylaxis: is nonselective β-blockade a contributory factor? Am J Emerg Med. 2013 Apr;31(4):759.e1-2.
    1. DeToledo JC. Lidocaine and seizures. Ther Drug Monit. 2000 Jun;22(3):320-2.

Source: PubMed

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