Washington Univeristy Plastic and Reconstructive Surgery is eager to offer a convenient alternative to the operating room for many common hand problems that require surgical treatment, such as carpal tunnel syndrome, trigger finger, cyst/mass removal, tendonitis, and other procedures.
Kelly Currie, MD, performs Wide Awake Local Anesthesia No Tourniquet (WALANT) hand procedures, which have been proven to be a safe alternative when compared to the traditional operating room setting and have no increase in complication rate. The WALANT technique is a patient-centered method of surgery that uses only local anesthesia and does not involve a tourniquet, so it can be done in the office setting.
This technique produces high patient satisfaction due to improved patient convenience and usually quicker access than can be offered by the operating room. There is no need for IV sedation or general anesthesia, which eliminates their associated risks. Additionally, the patient will know how the surgery went when they leave the office, instead of having to wait until their postop visit.
Below, Currie answers top questions from patients regarding Wide Awake Local Anesthesia No Tourniquet hand surgery.
WALANT stands for Wide Awake Local Anesthesia No Tourniquet and is a technique used for hand and wrist surgery procedures. The technique does not require any sedation, general anesthesia or tourniquets but uses local anesthesia medications, lidocaine and epinephrine, instead. The lidocaine blocks pain and epinephrine stops the bleeding. This allows the patient to remain fully awake during the procedure.
WALANT procedures offer several benefits for the patient, surgeon and hospital or clinic.
The patient spends less time in the hospital or clinic because there is no need to come in two hours before surgery like patients would to prepare for surgery in an operating room. WALANT patients do not experience nausea or vomiting that is associated with general anesthesia medications.
This means the patient can take less time off work and plan less time for childcare if needed. Oftentimes, there’s a possibility they can have the surgery the same day they meet with a surgeon because there is no need for preoperative testing or an operating room. It’s one less trip the patient must leave their house for, and is especially beneficial during the COVID-19 pandemic.
WALANT patients rarely experience nausea or vomiting that is associated with general anesthesia. Furthermore, because the patient is awake during the surgery, they have the opportunity to know exactly how the surgery is performed and can understand how what is happening in their body. Patients can demonstrate hand function during the procedure, allowing for an immediate evaluation of the treatment. This leads to fewer complications with postoperative rehab and can reduce time at the follow-up appointment. The WALANT technique has also been shown to reduce the postoperative opioid use for patients.
Some benefits of Wide Awake Local Anesthesia No Tourniquet:
- Less cost
- Quicker scheduling
- No IV needed
- No need for general anesthesia or sedation
- Quicker recovery time
- No need for fasting- patients can eat the day of surgery before the procedure
- No need to stop medications
- No need for preoperative testing (EKGs, labs, etc.)
Before using the WALANT technique, a surgeon will explain the anesthesia and procedure to the patient. The patient will be injected with the local anesthesia medication and may feel a little bit of burning at first, but after about a minute it’s numb. After the surgery is over, since the patient has already talked to their surgeon during the surgery, the patient can expect to go home immediately.
Patients will feel the initial needle poke, no worse than an IV, which is what they would have if they had a surgery in the operating room. Some patients have said that they are able to feel that the surgeon is doing something in their hand, but they do not feel anything painful. If the surgeon has to do an additional injection in another spot, he or she will do it where there is already numbness.
Yes, a patient can watch the surgery. Some patients like to watch so that they understand how the surgery works and can know how it is going, but a patient does not have to watch the surgery. Many will bring their phones, listen to headphones, or watch a movie, so that they are completely distracted.
The WALANT technique offers a variety of benefits for patients compared to a surgery done under sedation in the operating room. Patients prefer WALANT because they do not have to fast before their surgery and are free to eat throughout the day of their procedure. Furthermore, patients do not necessarily have to stop chronic medications, such as blood thinners, before surgery.
WALANT surgeries are also more convenient, as it takes up less time and usually allows a patient to drive home immediately, without the need for a driver. WALANT procedures are done in a reclined chair, so patients can adjust their position to remain comfortable during the surgery.
Moreover, patients prefer WALANT because they feel like they have more time with the surgeon and can ask them questions while it is happening. This leads to more patient satisfaction overall.
While WALANT is a great option for many patients, not everyone is a candidate for this type of procedure. Though it is normal to be nervous, people who are not good candidates are those who are very anxious and may not be able to cooperate with instructions. Other patients who would not receive this technique include people with high cardiac risk, severe vascular disease or allergies to the medication.
Pediatric patients are also not candidates for this kind of surgery.
Patients who are apprehensive should know that this procedure is very safe and is becoming increasingly popular throughout the world. If patients are not sure about the safety of the medication, they can keep in mind that the anesthesia medication used in WALANT procedures is the same that dentists use daily .
Patients who have a WALANT surgery commonly say that it was a lot easier than they thought it would be after surgery. WALANT patients are usually very happy and recommend the technique to their friends and family. Most patients become less anxious once they see that it’s not painful, and Washington University surgical teams provide comfort and distractions for patients if they need it.
Currie is currently taking patients for WALANT procedures at Christian Northeast and Alton Memorial Hospital. Both hospitals are a part of the BJC HealthCare system and affiliated with Washington University School of Medicine. Washington University Physicians is a highly active clinical practice group and is one of the largest academic clinical practices in the United States. Receiving care at an academic medical center means patients will receive care from top doctors with the latest applications of approved clinical research.