Related Experiment Video
Updated: May 6, 2026
05:39
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
2.2K
A Systematic Review and Meta-Analysis of Randomized Controlled Trials Comparing WALANT to Traditional Anesthesia in
Jad Lawand1, Ashraf Hantouly2, Fadi Bouri3
1University of Texas Medical Branch, 301 University Blvd. Galveston, Texas 77555.
Plastic and Reconstructive Surgery
|December 30, 2025
Summary
Wide-Awake Local Anesthesia No Tourniquet (WALANT) significantly reduces intraoperative pain in upper limb surgeries compared to tourniquet use. While effective, early postoperative pain reduction did not consistently exceed the minimal clinically important difference.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Pain Management
Background:
- Wide-Awake Local Anesthesia No Tourniquet (WALANT) presents an alternative to traditional tourniquet-assisted anesthesia for upper limb surgeries.
- This study systematically reviewed and meta-analyzed existing randomized controlled trials (RCTs) to compare WALANT with tourniquet use.
Purpose of the Study:
- To evaluate and compare pain scores and complication rates between WALANT and tourniquet techniques in upper limb surgeries.
- To determine the clinical significance of pain reduction achieved with WALANT.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines was conducted.
- Searched major databases (Medline, Embase, Cochrane, Web of Science, Scopus) for RCTs comparing WALANT and tourniquet use.
- Analyzed pain scores (injection, intraoperative, postoperative) and complication rates.
Main Results:
- Eleven RCTs involving 794 patients were analyzed.
- WALANT demonstrated a significant reduction in intraoperative pain (SMD -2.56) and early postoperative pain (0-6 hours; SMD -1.37).
- However, early postoperative pain reduction did not exceed the MCID; injection and late postoperative pain reductions were not clinically significant. Overall complication rates were comparable between groups.
Conclusions:
- WALANT is a safe and effective alternative for upper limb surgeries, offering significant intraoperative pain reduction.
- While WALANT provides substantial intraoperative pain relief, its superiority in early postoperative pain requires further consideration regarding clinical significance thresholds.
- Complication rates are similar between WALANT and tourniquet methods.
