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From wide awake surgery to office surgery.

Shafic Sraj1

  • 1Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV, 26506-9196, USA.

Journal of Hand and Microsurgery
|June 20, 2025
PubMed
Summary

Wide-Awake Local Anesthesia with No Tourniquet (WALANT) enables office-based hand surgery by removing anesthesia constraints. This review examines the safety, patient, and surgeon factors influencing the expansion of outpatient hand surgery settings.

Keywords:
Awake surgeryCosts and financial considerationsOffice surgery suitePatient experienceSafety

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Area of Science:

  • Orthopedic Surgery
  • Anesthesiology
  • Outpatient Medicine

Background:

  • Wide-Awake Local Anesthesia with No Tourniquet (WALANT) has revolutionized hand surgery procedures.
  • Anesthesia has historically imposed significant constraints on surgical settings.
  • The feasibility of performing hand surgery in an office setting has become increasingly recognized.

Purpose of the Study:

  • To review the current understanding of office-based hand surgery.
  • To analyze safety, societal, facility, patient, and surgeon perspectives on this model.
  • To identify barriers hindering the broader adoption of office-based hand surgery.

Main Methods:

  • Literature review and synthesis of existing data.
  • Analysis of safety protocols and requirements for office settings.
  • Examination of perspectives from various stakeholders including patients and surgeons.

Main Results:

  • WALANT facilitates the shift of hand surgery from traditional operating rooms to office environments.
  • Successful implementation requires adherence to specific safety requirements.
  • Multiple factors influence the viability and expansion of office-based hand surgery.

Conclusions:

  • Office-based hand surgery is a safe and viable option when appropriate safety measures are in place.
  • Addressing identified barriers is crucial for further expansion of this surgical model.
  • The adoption of WALANT supports the decentralization of surgical care.