What is “Wide Awake Hand Surgery” (WALANT)

Traditionally, many hand surgery procedures were (and still are) performed with the patient “put under” with sedation or general anesthesia. Even relatively routine hand surgeries,  including such surgeries as carpal tunnel release, surgical repair of tendons and removal of tumors or masses, involved sedation or general anesthetic that rendered the patient partially or fully unconscious during the procedure.

But thanks to new surgical techniques, many of these surgeries can now be performed under local anesthesia only (leaving the patient awake and conscious), sometimes right in the hand surgeon’s office. This technique is known known as “Wide Awake Hand Surgery” or “WALANT” which stands for wide awake local anesthesia [with] no tourniquet.

In this article, board certified Macomb County Hand Surgeon Dr. Uzma Rehman explains how “Wide Awake Hand Surgery” (WALANT) works, and what its advantages are for certain patients.

Traditional Hand Surgery

The most common and universally accepted method of performing hand surgery has long consisted of applying an extremely tight tourniquet to the arm – which stops the blood flow to the area on with the surgeon is operating, so she has a bloodless area in which to perform the repairs. Sedation was required to offset the intense pain of the tourniquet and the surgery.

Wide Awake Hand Surgery” (WALANT)

But, during “Wide Awake Hand Surgery” (WALANT) lidocaine is combined with epinephrine to avoid the need for both the tourniquet and sedation.

The epinephrine acts as a “vasoconstrictor” – meaning it closes the veins, to controls bleeding. So a tourniquet is not needed. And the lidocaine thoroughly numbs the area so the patient does not feel pain during the surgery.

For decades, dentists and oral surgeons have safely used epinephrine combined with lidocaine, to control bleeding and numb the pain. Now the same principal is being successfully applied to hand surgery.

The treated area is still “draped” so the patient does not have to watch it – and most patients relax and listen to music or watch TV during the WALANT surgery – without feeling any pain.

Benefits of Wide Awake Hand Surgery (WALANT)

Since the hand surgeon can safely control bleeding with the epinephrine, no painful tourniquet is needed so there is no need for sedation or general anesthesia.

Local anesthesia is always a much safer alternative to general anesthesia because it does not put the entire body stress. Local anesthetic does not affect the central nervous and cardiopulmonary (heart and lung) systems like general anesthetic does – since local anesthesia is confined to the treatment area and does render the patient unconscious.

Additionally, the recovery from the local anesthesia is also faster, with fewer risks and side effects.  While general anesthetic is still necessary in many surgeries, any time it can be avoided and replaced with a local anesthetic reduces risks and shortens recovery time.

And, because the patient remains awake during the surgical procedure, the hand surgeon can more readily assess how well the repair is working and make adjustments. Postoperative pain and swelling are also typically less with Wide-awake Hand Surgery.

As an additional benefit, WALANT surgery can also more safely be used in patients who have underlying medical conditions or complications – or who take blood thinner medications – which might otherwise prevent them from having surgery.

Procedures Wide-awake Hand Surgery (WALANT) Is Used For

Not all procedures will be able to be performed using Wide Awake Hand Surgery” (WALANT) – but in many cases it can be used for:

  • Carpal tunnel release
  • Removal of tumors or masses
  • Trapeziectomy (arthritic bone removal)
  • Dupuytren’s contracture release
  • Fracture fixation
  • Ligament repair
  • Osteotomy (repair, reshaping or removal of bone)
  • Joint replacements (fingers)
  • Wrist and elbow nerve procedures
  • Tendon and soft tissue repairs

Wide Awake Hand Surgery (WALANT) – Macomb County

Only a skilled and highly experienced hand surgeon, like Dr. Uzma Rehman in Macomb County, can assess your condition and determine whether WALANT surgery is right for your individual arm, elbow, wrist, finger or hand surgery.

If you are suffering from any condition of the hand, wrist, arm or fingers, schedule a consultation with Dr. Rehman at her Macomb County or Oakland County office today. The earlier any medical condition is addressed the faster the recovery, the better the results, and the higher the chances that long term problems will be avoided.

Doctor Rehman will assess your individual situation, and prescribe the treatments that are best for your condition.

Wide-awake Hand Surgery (WALANT) – Macomb County: 586.532.0803