What is WALANT?

A breakthrough surgery is now being offered at University Orthopaedic Associates (UOA).

Hand surgery has traditionally been performed under anesthesia due to the common use of a tourniquet. While the tourniquet prevents blood flow to the limb in order to achieve a bloodless operative procedure, it is particularly painful for an awake patient.

However, this dynamic has changed with an important innovation in surgical technique. It is known as “WALANT,” which stands for Wide Awake Local Anesthesia No Tourniquet.

In this revolutionary procedure, the tourniquet has been replaced by two medications in order to avoid anesthesia. These medications are lidocaine (to block pain), epinephrine (to stop bleeding – a task formerly achieved with the tourniquet) and sodium bicarbonate (to buffer the solution to make it nearly painless).

At UOA, our surgeons have performed this technique for a variety of hand surgeries, including carpal tunnel syndrome and trigger finger. WALANT is also available for de Quervain’s syndrome, flexor tendon repairs, tendon transfers, several arthritis surgeries for hand and wrist, excisions of masses and other procedures. Among others, this surgery particularly benefits older people with arthritis for whom surgery could relieve significant pain, but for whom anesthesia is contraindicated.

The benefits of WALANT hand surgery include:

• Less cost and shorter recovery
• No hospitalization as the surgery is performed on an out-patient basis in UOA’s University Surgery Center for Ambulatory Surgery (UCAS)
• No IV insertion
• No need to fast or stop taking any medications prior to surgery (this is particularly important for diabetics and those on blood thinners)
• The ability for patients to demonstrate limb function during the procedure per surgeon’s request, allowing for evaluation of repair

With WALANT, patients can:

• Avoid pre-operative testing (blood work, EKG, etc.)
• Avoid recovery from sedation
• Avoid the risk of complications that may occur with anesthesia
• Conduct a useful conversation with the surgeon on the progress and nature of the procedure
• Drive to and from surgery (no escort to drive necessary)

Patient satisfaction with this surgery is extremely high. If you have any conditions or injuries that may benefit from WALANT surgery, we encourage you to make an appointment to discuss the possibilities of this procedure with our experts.