Hand Surgery and WALANT

David C. Hirsch, MD October 21st, 2021


There is understandable trepidation about being in a hospital in today’s environment. The field of Orthopaedic Hand Surgery has been moving away from hospital-based procedures and into more accessible surgery centers. This movement has coincided with a new way of performing common hand and wrist surgical procedures: WALANT or Wide Awake Local Anesthesia No Tourniquet. 

Traditionally, all surgical procedures of the hand and wrist were performed with some form of general anesthetic.  WALANT surgery has been gaining significant popularity for a variety of reasons and in the future we anticipate this form of surgery to become an ever more common practice for hand and wrist surgical procedures.

What is WALANT surgery?

Procedures done under WALANT are performed the same day, without a hospital stay, and without general sedation or general anesthesia. Hence, this allows patients to drive themselves to and from the surgery should they choose to do so. A local anesthetic, often lidocaine with epinephrine (adrenaline) or a combination of lidocaine with epinephrine and a longer lasting local anesthetic, are injected into the region of the hand or wrist where the procedure is to be performed. 

After allowing the numbing medication to take effect, the surgical procedure can be performed without pain and without the inherent risk of general sedation or general anesthesia. Epinephrine (adrenaline) is advantageous for two reasons: 

1. Epinephrine acts as a local vasoconstrictant, limiting bleeding at the site of the procedure and obviating the need for a tourniquet. Tourniquets can be uncomfortable and unpleasant for patients. In the past, general anesthesia was administered to reduce the discomfort from tourniquets.
2. Epinephrine keeps the injected anesthetic in the surgical region for a longer period of time which contributes to longer pain relief after the operation is completed. 

With WALANT, no general anesthesia and no tourniquet need to be used.

What are the benefits of WALANT surgery?

Surgery without sedation or anesthesia offers multiple benefits for patients. WALANT has been shown to: 
Decrease cost
Decrease time spent at the surgery center
Decrease the need for preoperative testing and medical clearance

In addition, patients do not need to make changes to their medications prior to or after surgery. For example, a patient with severe numbness and tingling from carpal tunnel syndrome that prohibits proper sleep at nighttime can be considered for surgery without having to see their primary care doctor or undergo laboratory testing. Patients who were perhaps previously considered “too sick” to undergo elective surgery can now be considered for procedures that could offer significant relief of their symptoms.  

Furthermore, WALANT surgery enhances the patient-surgeon relationship by allowing the surgeon to converse with the patient during the surgery. Specifics of the procedure, the recovery, and the rehabilitation can be reviewed upon consultation with your Hand Surgeon.

What are common WALANT hand procedures?
Common Orthopaedic Hand Surgery procedures performed under WALANT include carpal tunnel release, trigger finger release, mass excisions and DeQuervain’s release. Certain tendon repairs can also be performed under WALANT, which has been shown to improve patient outcomes. 

Where can I have WALANT hand surgery?
The Hand Surgeons at Rothman Orthopaedics have all completed additional fellowship training in the field of Hand and Wrist Surgery and the use of WALANT.  We feel that being able to offer this type of surgery to our patients is important.  There can understandably be a high level of anxiety about being awake during an operation and our goal is to make our patients comfortable in a surgical environment that is safe and beneficial to them. As two of the newest hand surgeons with Rothman Orthopaedics we hope that you consider a consultation with us to see how WALANT surgery may benefit you.

Dr. David Hirsch, Orlando, FL
Dr. Justin Kistler, Philadelphia, PA

For more information on hand and wrist surgeries, or to make an appointment, please visit RothmanFL.com for the Orlando region or Rothmanortho.com for the Philadelphia region.

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