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Wide-Awake Local Anesthesia No Tourniquet in Adolescent Hand Surgery: A Systematic Review
Hannah Polley1, Benjamin Blackman1, John Tristan Cassidy2
1School of Medicine, University of Limerick, Limerick, Ireland.
Journal of Hand Surgery Global Online
|September 11, 2025
Summary
Wide-awake local anesthesia no tourniquet (WALANT) shows promise in adolescent hand surgery, potentially reducing procedure time and hospital stays. Further research is needed due to limited evidence on its safety and efficacy in this age group.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Anesthesiology
Background:
- Wide-awake local anesthesia no tourniquet (WALANT) is established in adult hand surgery for functional assessment and reduced systemic effects.
- Adolescent application of WALANT is uncertain due to potential adherence and cooperation challenges.
- This review synthesizes current evidence on WALANT use in pediatric patients undergoing hand surgery.
Purpose of the Study:
- To compile and evaluate existing evidence on the safety and feasibility of WALANT in adolescent hand surgery.
- To assess the potential benefits of WALANT in pediatric patients, including functional outcomes and patient experience.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Medline, Embase, and Scopus databases up to December 2024.
- Included studies were comparative and cohort designs, analyzing outcomes such as procedure duration, hospital stay, and pain.
- A narrative review approach was employed due to heterogeneity in reported outcomes.
Main Results:
- Four studies comprising three case-control studies (n=287) and one case series (n=6) were included, totaling 166 WALANT surgeries.
- The mean patient age was 14 years (range 7-20). Common procedures included tendon repair and ganglion removal.
- A low conversion rate to general anesthesia (0.6%) was observed.
Conclusions:
- Evidence for WALANT in adolescents is currently limited.
- WALANT may offer benefits such as reduced procedure time, shorter hospital stays, and improved pain management in pediatric hand surgery.
- Further high-quality studies are warranted to establish definitive safety and efficacy profiles.
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