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WALANT Resources

Wide Awake Local Anaesthesia with No Tourniquet

Wide Awake Hand Surgery – or more commonly referred to as WALANT is a technique which uses a mixture of lidocaine and adrenaline to provide anaesthesia and haemostasis in one injection. It is used in a “field block” technique where large volumes of mixture are infiltrated everywhere that needs to be anaesthetic during the case.

On this page, you will be able to access to videos on how to get started and safely administer anaesthetic as well as demonstrations of elective and trauma procedures, a list of useful papers to read, as well as a range of additional resources (including the BSSH Wide Awake Hand Surgery handbook and a quick-reference guide to draw-up a WALANT mixture).  The videos have been divided into three categories: introduction and basic sciences, elective hand pathologies and hand trauma scenarios.

WALANT basics and introduction

  • Safe use of adrenaline (epinephrine) in the fingers
  • Wide Awake Hand Surgery Basics
  • Safety and value of Field Sterility
  • Introduction to WALANT
  • Pearls of wisdom using WALANT technique
  • What do Patients think of WALANT
  • Phentolamine Rescue
  • Why patient satisfaction increases with walant
  • An example of a Walant setup at Saint John Regional Hospital (Canada)
  • Single subcutaneous Injection over Middle of the the Proximal phalanx with Lidocaine and Epinephrine (SIMPLE block) technique
  • What is WALANT 

Click to watch​​​​

 

Elective hand pathologies

  • DeQuervain's Release
  • EIP to EPL Tendon Transfer
  • Reconstruction of 4th and 5th Extensor Tendons (using Palmaris Longus graft)
  • FPL rupture following volar wrist plate - reconstructed using Palmaris Longus
  • What is Lacertus Syndrome
  • Injection technique for surgery involving MCP joint capsulotomy
  • PIPJ Fusion (using Extremity Medical's APEX implant)
  • Sagittal Band Reconstruction
  • How to inject LA for a Trapeziectomy (dorsoradial approach)
  • Trigger Finger / Thumb Surgery

Click to watch

 

Hand trauma scenarios

  • Extensor tendon repair using Walant and relative motion splint
  • Flexor tendon repair using WALANT - part 1 (testimonials and injection technique)
  • Flexor tendon repair using WALANT - part 2 (surgical approach)
  • Flexor tendon repair using WALANT - part 3 (tendon retrieval)
  • Flexor tendon repair using WALANT - part 4 (tendon repair inside an intact sheath)
  • Flexor tendon repair using WALANT - part 5 (post-op therapy)
  • FPL direct repair of 5 week old injury
  • K-wire fixation of proximal phalanx

Click to watch

 

Useful papers and essential reading

Lalonde D, Eaton C, Amadio P, Jupiter J. Wide-awake hand and wrist surgery: a new horizon in outpatient surgery. Instr Course Lect. 2015;64:249-59.

Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. JAAOS. 2013;21(8):443-7.

Lalonde D, Martin A. Tumescent local anesthesia for hand surgery: improved results, cost effectiveness, and wide-awake patient satisfaction. Archives of plastic surgery. 2014;41(4):312.

Hyatt B, Rhee PC. Wide-Awake Surgical Management of Hand Fractures: Technical Pearls and Advanced Rehabilitation. Plast. Reconstr. Surg. 143: 800, 2019.

Bravo D,  Towsend C, Tulipan J, Ilyas A. Economic and Environmental Impacts of the Wide-Awake, Local Anesthesia, No Tourniquet (WALANT) Technique in Hand Surgery: A Review of the Literature. J Hand Surg Glob Online. 2022 Jun 17;4(6):456-463 PMID: 36425376

Kurtznman J, Etcheson J, Koehler S. Wide-awake Local Anesthesia with No Tourniquet: An Updated Review. Plast Reconstr Surg Glob Open. 2021 Mar 26;9(3):e3507. PMID: 33786267

Morris M, Rolf E, Tarkunde Y, Dy C, Wall L. Patient Concerns About Wide-Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery. J Hand Surg Am. 2022 Dec;47(12):1226.e1-1226.e13. PMID: 34774346

Lawand J, Hantouly A,  Bouri F, Muneer M, Farooq A, Hagert E. Complications and side effects of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta-analysis. Int Orthop. 2024 Feb 17;48(5):1257–1269. doi: 10.1007/s00264-024-06104-9

 

Additional resources / downloads

BSSH Handbook on Wide-awake Hand Surgery (2025)

Quick Reference Guide (2025)

 

The contents of the videos featured are for educational purposes only and are available intended to demonstrate the WALANT technique. The BSSH does not endorse any particular technique, approach or implant. 

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