WALANT Hand Surgery
WALANT, which stands for “wide awake local anesthesia no tourniquet,” is a relatively new surgical technique in the U.S., though it is widely used throughout the world. Following are answers to some of the most frequently asked questions about the procedure. If you have additional questions, please discuss them with your hand specialist. We want you to fully understand any medical procedure that might be an option for you.
What is WALANT?
WALANT is a technique used to treat some types of hand and wrist injuries. During the procedure, which often can be done in a hand specialist’s examination room, the patient is given a local anesthesia that numbs the surgical area rather than a general anesthesia that causes a patient to be fully asleep.
This treatment can offer a number of advantages over traditional hand surgery performed in an operating room. These include:
- Convenience: A person treated with a WALANT procedure typically spends less time in the hospital or clinic because, unlike traditional surgery, the procedure does not require extensive preoperative preparation. And because general anesthesia is not used, there is no need to limit food intake before surgery, and many people who take medications that might interfere with general anesthesia—blood thinners, for example—likely will not have to stop taking those drugs prior to a WALANT procedure.
- Quick recovery: A person treated with a WALANT procedure receives local anesthesia rather than general anesthesia medications. This eliminates any nausea or vomiting associated with general anesthesia and allows patients to drive themselves home after the procedure.
- Easy scheduling: Because there is no need for fasting or preoperative testing, it is often easier to schedule this procedure. Occasionally, some patients have the opportunity to be treated on the same day they meet with their surgeon.
- Better results: Because patients are awake during a WALANT procedure, they have more time to talk with their surgeon and ask questions about recovery. Often, the patient is able to demonstrate hand function during the procedure, which provides the surgeon an immediate evaluation of the treatment. This can mean fewer complications during post-operative rehabilitation work and can save time during follow-up appointments.
This procedure is very safe. We use the same kind of local anesthesia that dentists use every day.
Before your WALANT procedure, your surgeon will discuss each step of the process with you. First, local anesthesia is administered. Patients normally feel a little burning sensation before the numbing takes effect. This is a minor discomfort and is the only part of the procedure that you should be able to feel. Next, the surgeon makes the surgical corrections needed to treat the condition. There is no lengthy post-operative recovery in the clinic, and once the surgery is over, most people are able to go home immediately.
You will feel the initial needle poke that delivers the local anesthesia; this sensation is much the same (or less) as any discomfort felt when an IV is placed prior to traditional surgery. This should be the only pain you feel during the procedure. If the surgeon determines that another injection of local anesthesia is needed, it will be administered in an area of your hand that is already numb. Some people report that they can sense the surgeon’s work during the procedure but do not feel pain.
Yes, some people like to watch so that they understand how the surgery works. However, you do not have to. Many people we treat are more comfortable looking away and listening to music or watching movies on their phones.
We use this technique to treat people with trigger finger, carpal tunnel syndrome, De Quervain’s tenosynovitis and other forms of tendonitis.
While the treatment is a great option for many patients, it is not suitable for everyone. Though it is normal to be nervous during many medical procedures, if you tend to become extremely anxious during standard medical procedures and examinations, you may not be able to follow the instructions the surgeon gives you during the procedure. The level of anxiety you are likely to experience will help determine whether you are a candidate for WALANT.
Also, people with some forms of heart disease or other cardiac risk, severe vascular disease or allergies to lidocaine or other medication used in this procedure also may not be candidates for WALANT.
WALANT is not available to pediatric patients.