WALANT

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.