Glossary Procedure
WALANT
Also known as wide-awake hand surgery wide-awake local anaesthesia no tourniquet lidocaine-with-epinephrine local anaesthesia
WALANT is local-anaesthetic-only hand surgery using lidocaine combined with epinephrine
for haemostasis, performed without sedation or upper-arm tourniquet. The technique was
popularised by Donald Lalonde and colleagues in Canada from the early 2000s and has been
progressively validated for a wide range of hand procedures, including elective primary
flexor tendon repair. The principal clinical advantages for tendon repair are the option
to test the construct under active patient flexion (intraoperative total active movement
examination, iTAMe) before closure, and the avoidance of tourniquet-related discomfort
and operative-team logistics. A 2024 systematic review and meta-analysis of 624 fingers
reported no inferiority to general or regional anaesthesia in rupture, adhesion, or
reoperation rates, with a small but statistically significant favouring of WALANT for
postoperative range of motion. Reasonable indications for general or regional anaesthesia
remain: multi-digit injury, local-anaesthetic intolerance, paediatric patients, and
patients with anxiety severe enough to prevent intraoperative cooperation.