Description of WALANT technique in open bone and ligament wrist surgery

Brutus, Jean Paul; Chang, Min Cheol; Ahmad, Amir Adham; Apard, Thomas

doi:10.1016/j.hansur.2023.10.004

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2024

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“…Every year, new reports that push boundaries are published. There are recent reports of wrist surgery, radius, and ulna fracture plating, elbow surgery, clavicle plating, and major limb amputations (71,72,73,74,75,76,77,78,79,80). Although the cost benefits of this approach in these cases are evident, the absolute indications for these procedures are not yet completely clear and are still limited to preferences or circumstances outruling other options (66,81,82,83).…”

Section: Future Prospectsmentioning

confidence: 99%

WALANT surgery of the hand: state of the art

Degreef,

Lalonde

2024

EFORT Open Reviews

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Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25–1% lidocaine, with 1:100 000–1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.

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