Wide-Awake Local Anesthesia with No Tourniquet (WALANT) for Hand Surgery: Safety and Efficacy—A Case Series
Aditya Verma1*, Amulya Aggarwal2, Harish Bansal3
1Wrightington Hospital, WWL NHS Trust, United Kingdom.
2Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. 3Rajasthan Jaipuria Hospital, India.
*Corresponding Author: Aditya Verma, Wrightington Hospital, WWL NHS Trust, United Kingdom.
https://doi.org/10.58624/SVOAOR.2025.05.023
Received: December 02, 2025
Published: December 17, 2025
Citation: Verma A, Aggarwal A, Bansal H. Wide-Awake Local Anesthesia with No Tourniquet (WALANT) for Hand Surgery: Safety and Efficacy—A Case Series. SVOA Orthopaedics 2025, 5:6, 142-147. doi: 10.58624/SVOAOR.2025.05.023
Abstract
Background: Wide-awake local anesthesia with no tourniquet (WALANT) represents an alternative approach to traditional anesthesia methods in hand surgery. This technique combines local anesthetic infiltration with epinephrine-induced vasoconstriction to achieve hemostasis without systemic anesthesia or tourniquet use.
Methods: This case series describes the clinical outcomes of patients undergoing hand surgery using WALANT technique at our institution. Cases included carpal tunnel release (n=5), fracture fixation (n=4), tendon repair (n=1), and soft tissue tumor excision (n=1). Outcome measures included pain control, hemostasis quality, complications, recovery time, and functional outcomes at follow-up.
Results: All 11 procedures were completed successfully with adequate anesthesia and hemostasis. One patient developed a self-limited postoperative hematoma following carpal tunnel release, resolving without intervention within 3 months. All other cases were uncomplicated. Patients reported minimal pain during procedures and were discharged the same day or within 24 hours. Follow-up assessments demonstrated satisfactory functional recovery and no wound complications.
Conclusions: WALANT can be safely and effectively applied to appropriately selected hand surgical procedures, offering advantages including rapid recovery, reduced hospital costs, real-time functional assessment, and enhanced patient experience. Careful patient selection and technical proficiency are essential for optimal outcomes.
Keywords: Wide-Awake Anesthesia, Hand Surgery, Local Anesthesia, Hemostasis, Case Series