Delaney Tyl, BS1; Mackenzie Elting, BS1; Srivennela Veeramachaneni, BS1; Alessandra Ottley, BS2; Christopher Rennie, DO PGY-13; Leighann C. Krasney, DO MPH4
1 Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Tampa, FL
2 Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL
3 Philadelphia College of Medicine, Philadelphia, PA
4 Mountain Valley Orthopaedics, Stroudsburg, PA
ABSTRACT
Wide Awake Local Anesthesia No Tourniquet (WALANT) has emerged as an increasingly utilized technique in hand and upper extremity surgery. This study reviews current literature to better characterize how WALANT is being applied in hand surgery, with a focus on procedural representation, safety, and patient satisfaction across a range of upper extremity procedures.
PubMed, OVID Medline, CINAHL, and Web of Science were searched according to PRISMA guidelines with the following search terms: “walant”, “wide awake local anesthesia no tourniquet”, “wide awake local anesthesia hand surgery”, “wide awake local anesthesia”. Systematic reviews and meta-analyses published within the past five years evaluating WALANT in hand and upper extremity surgery were included. A total of 486 articles were screened, resulting in the identification and inclusion of 16 studies in the final analysis.
Among the included studies, the most commonly evaluated procedures were carpal tunnel release (43.8% of studies), trigger finger release (37.5%), and flexor tendon repair (31.3%). Additional procedures included distal radius fracture fixation (18.8%), De Quervain’s tenosynovitis release (18.8%), trapeziometacarpal joint arthroplasty (12.5%), Dupuytren’s contracture release (12.5%), and proximal median nerve release for lacertus syndrome (6.3%). The reviewed literature demonstrated a low incidence of complications comparable to or lower than those associated with traditional anesthetic techniques.
When reported, patient satisfaction was consistently high and is attributed to reduced perioperative anxiety, avoidance of sedation, convenience, and perceived faster recovery. Patients also often reported better pain control after WALANT compared to other forms of anesthesia.
This scoping review supports WALANT as a safe, efficient, and patient-preferred anesthetic technique across a growing range of upper extremity procedures. These findings suggest an expanding role for WALANT and support its broader consideration in orthopedic surgical practice, particularly in outpatient, in-office, and resource-limited settings.
Keywords: WALANT, hand surgery, wide awake local anesthesia no tourniquet
