Brachial Plexus Nerve Transfer Under Wide Awake Local Anesthesia No Tourniquet

Brachial plexus injuries commonly require nerve transfers, traditionally performed under general anesthesia. We propose the wide awake local anesthesia no tourniquet (WALANT) technique, utilizing lidocaine with epinephrine to achieve anesthesia and maintain a bloodless surgical field without general anesthesia. Our initial experience with nerve transfers (eg, ulnar-to-musculocutaneous for elbow flexion) entirely under WALANT demonstrates excellent patient tolerance, minimal pain, and high satisfaction. Intraoperative nerve identification was enhanced by patient feedback and nerve stimulation without anesthesia-related complications. Recovery was rapid, and functional outcomes matched conventional methods. WALANT offers a safe, cost-effective, and patient-friendly alternative, improving surgical accessibility by reducing anesthesia risks and enabling procedures in resource-limited settings.