Surgery
anaesthesia (typically lidocaine) and epinephrine, without sedation or a tourniquet, during hand surgery. As with any new technique, it took time to become broadly accepted and grow in popularity but, since 2017, it has become increasingly widespread, with many healthcare societies and associations promoting the approach. The below list describes common procedures in the hand and wrist which may be performed under WALANT:3 Hand l Tendon decompression. l Flexor and extensor tendon repair, tenolysis and transfer.
l Nerve decompression. l Carpal tunnel. l Cubital tunnel.
l Radial nerve and median nerve decompression in the forearm.
l Nerve repair. l Dupuytren fasciectomy / dermofasciectomy. l Soft tissue procedures including ganglion and other mass excision / biopsy.
l Finger joint arthroplasty or fusion. l Phalangeal fracture fixation.
Wrist l Trapeziectomy. l Wrist arthroscopy. l Wrist fusions. l Distal radius fracture fixation.
In addition, WALANT has been described for use in a range of other upper and lower limb
procedures, including: Upper limb l Forearm fractures. l Clavicle fractures.
Lower limb l Patellar fracture fixation. l Pretibial haematoma. l Peroneal nerve decompression. l Ankle fracture fixation. l Ankle arthroscopy. l Ankle fusion.
Undertaking procedures with wide awake patients with no motor blockade allows soft tissue repairs and fracture fixations to be tested for adequacy, motion and alignment immediately with intra-operative adjustments as necessary. This allows finessing of function in a way not possible otherwise. Procedures outside the hand, including on the wrist, long bones and lower limb are highly advanced techniques and should be carried out only by those very well trained and experienced in WALANT techniques. The WALANT technique provides numerous benefits, including but not limited to:
Patient l Lack of sedation avoids complications resulting from comorbidities, side-effects including nausea, vomiting and prolonged sedations.
l Reduces anxiety associated with general or regional anaesthesia.
l No motor block – patient more engaged with their care, including intra-operative decision making. Intra-operatively the patient can test their care and offer feedback.
l Haemostasis reducing chance of haematoma, scarring and wound dehiscence. l Post-operative recovery enhancement with
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www.clinicalservicesjournal.com I October 2025
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