WALANT Special Issue
Wide-Awake Local Anesthesia, No Tourniquet Surgery in the PhilippinesThe use of wide-awake local anesthesia, no tourniquet (WALANT) has been adapted by most hand surgeons in the Philippines. This is especially true for centers with a large volume of patients needing specialized care for the hand. The use of WALANT has enabled surgeons to do procedures on an outpatient basis, thus potentially creating cost-saving measures for patients and health care facilities. Aside from common outpatient procedures like carpal tunnel syndrome, trigger finger, and de Quervain tenosynovitis, open reduction internal fixation of hand fractures, acute tendon repairs, tendon transfers, and reconstructions have been performed under WALANT as outpatient procedures.
Novel Use of the Wide-Awake Local Anesthesia No Tourniquet Technique for Release of Spastic Upper LimbsWide-awake local anesthesia no tourniquet procedures allow the patient to remain conscious and cooperative during surgery, allowing intraoperative assessments of hand function. This is useful in spastic hand surgeries, allowing an instant assessment of the muscle releases and residual power, thus guiding an optimal balance with the best possible functional outcomes. We describe the novel use of wide-awake, local anesthesia, no tourniquet surgery in spastic upper-limb surgery in forearm flexor-pronator release, thumb-in-palm and intrinsic-plus deformity correction, and elbow flexor release.
Current Evidence Involving WALANT SurgeryWide-awake local anesthesia no-tourniquet (WALANT) surgery is an attractive option for hand surgeons, particularly during resource-scarce periods, as it eliminates dependence on main operating rooms or hospital-based procedures. The limited prepping or draping used for WALANT field sterility is as effective, if not more effective, than standard sterile prepping or draping. Patient anxiety surrounding WALANT surgery is similar to or less than that of general or local anesthesia with or without tourniquet.