Wide Awake Hand Surgery

June 2019

Wide Awake Hand Surgery - “WALANT”

Fremont Orthopaedics, Orthopedics, Lander, Riverton

Dr. Francisco explains wide awake hand surgery.

Hand Surgery has traditionally been performed with the use of a tourniquet in order to provide better visualization. However, a tourniquet can be quite painful for the awake patient, making anesthesia necessary.

An alternative to tourniquet hand surgery is to use two medications administered locally to accomplish surgery in a safe, painless manner.  Lidocaine blocks pain, and epinephrine stops bleeding.  This technique is known as “WALANT”-Wide Awake Local Anesthesia No Tourniquet. Because the patient no longer requires anesthesia, these procedures can be performed in an office based setting, utilizing a sterile field and instruments.

WALANT hand surgery is very similar to going to the dentist for a procedure.  There is no need for fasting or preoperative testing. Fremont Orthopaedics is now offering WALANT for select procedures, including trigger finger release, cyst removal, carpal tunnel release, nailbed repair, and tendon repair. Talk to our surgeons to find out whether WALANT surgery could be an option for you.


The Advantages of WALANT Hand Surgery Are: 

  • No need to spend time and money to obtain preoperative testing (labwork, EKG, etc)
  • Avoid costs associated with anesthesia (anesthesiologist, medications, monitoring)
  • No need for IV
  • Spend less time and money at surgery center
    • Less time spent preoperatively being interviewed by anesthesiologist
    • Less time spent postoperatively being monitored by recovery nurse
  • Get to talk to surgeon during the surgery for post-operative advice on how to care for hand, rehabilitation, etc.
  • Get to see repaired structures working during the surgery. (For example, repair of tendon lacerations or tendon transfer to ensure appropriate tension)
    • For the patient this can improve understanding of the repaired pathology to enhance compliance in rehabilitation
    • For the surgeon, the ability to see a repaired structure in action can avoid complications and increase likelihood of good outcome
  • No need to fast and can resume regular diet immediately
  • No need to change medication schedules
    • Diabetics can maintain their medication regimen since their diet is uninterrupted
    • Patients who require blood thinners can generally continue them. Avoid risks associated with being off blood thinner

Patient Satisfactions:

100 consecutive patients were polled postoperatively

  • 91% found it was less painful or comparable to procedures done under local at the dentist’s office.
  • 86% would prefer to be awake for further hand surgery
  • 90% would recommend wide awake surgery to a friend

[1]Teo I, Lam W, Muthayya P, Steele K, Alexander S, Miller G.  Patients’ perspective on wide-awake hand surgery-100 consecutive cases. J Hand Surg Eur Vol. 2013 38(9)