Bone Bulletin



As the name might imply, “wide awake local anesthesia no tourniquet” (WALANT) is a surgical method to perform hand surgery using only a local anesthetic without the use of a tourniquet or any sedation and general anesthetics. The WALANT technique takes advantage of the vasoconstrictive effects of epinephrine combined with the local anesthetic effects of lidocaine to create a surgical field that does not require a tourniquet or general anesthesia.1 The main contributor is epinephrine, which decreases bleeding in the surgical field while also lengthening lidocaine’s absorption and effect.2 When first introduced to the surgical world, the WALANT technique was met with some resistance, mostly due to the wide-based belief that high usage of epinephrine can cause digital ischemia; however, several large-scale studies have concluded that epinephrine can be used safely in the hand.3 The benefits of WALANT hand surgery are many, including safety, cost, and convenience. Subsequently, WALANT has enjoyed a steady uptick in utilization nationally and internationally, yielding a need to explore this topic further.2

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