Managing complex hand, wrist, and forearm injuries with WALANT: A case-based technical report

Wide-Awake Local Anaesthesia No Tourniquet (WALANT) is an effective and increasingly utilised method of anaesthesia for the surgical treatment of injuries to the hand, wrist, and forearm. Despite its proven safety, efficacy, and cost-effectiveness, the adoption of WALANT has been limited, particularly in Western healthcare systems where general and regional anaesthesia predominate, especially in complex injuries. We report the application of WALANT in a variety of hand surgical procedures for the treatment of complex injuries ranging from complex fractures to multiple soft tissue injuries in adult patients. WALANT's benefits includes active intraoperative testing of the strength of tendon repairs and osteosynthesis which applies also to complex injuries. Additionally, nerve repairs can also be actively tested under WALANT, leading to more effective and safer postoperative rehabilitation. We anticipate that WALANT will soon see broader application even in more complex surgeries, extending to the surgical treatment of complex injuries around and above elbow.