Is WALANT Really Necessary in Outpatient Surgery?

Abstract

Introduction: The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has revolutionized outpatient hand surgery, enabling procedures such as carpal tunnel release and trigger finger release without a tourniquet. Its benefits include patient cooperation during surgery, especially for tendon repairs. However, WALANT has limitations, including a steep learning curve, longer operative preparation time, and risks such as digital ischemia and adrenaline-induced cardiac ischemia. This study evaluates the safety and effectiveness of local anesthesia with a tourniquet for short-duration outpatient hand surgeries. Materials and Methods: This case series included 300 patients undergoing carpal tunnel or trigger finger release between February 2023 and March 2024. Local anesthesia with lidocaine was administered, and a tourniquet was applied to the proximal arm. Demographic data, operative time, and pain levels during tourniquet use (measured by VAS) were recorded. Results: The average surgical time was 12 min. Most procedures involved carpal tunnel release. The average VAS pain score was 3.73, with older patients and longer surgeries reporting higher discomfort. Tourniquet release was required in only 1% of cases due to discomfort. Conclusions: For short outpatient hand surgeries, local anesthesia with a tourniquet is a safe, effective alternative to WALANT, challenging its routine use and highlighting the need for tailored anesthetic approaches.