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WALANT in Hand Trauma Surgery: Safety and Efficacy
Ayla A Hohenstein1, Roman Matros1, Cam Tu Nguyen1
1Department of Plastic and Hand Surgery, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg im Breisgau, Germany.
Hand (New York, N.Y.)
|April 30, 2026
Summary
Wide Awake Local Anesthesia No Tourniquet (WALANT) significantly speeds up emergency hand surgery compared to general anesthesia, with similar safety outcomes. WALANT offers faster treatment without compromising patient care in urgent surgical settings.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Emergency Medicine
Background:
- Emergency hand surgeries require timely intervention.
- Traditional anesthesia methods may cause delays.
- Evaluating alternative anesthesia techniques is crucial for efficiency.
Purpose of the Study:
- To compare the time efficiency of Wide Awake Local Anesthesia No Tourniquet (WALANT) versus general/plexus anesthesia for emergency hand surgery.
- To assess the safety and complication rates associated with WALANT in this setting.
Main Methods:
- Retrospective analysis of 812 emergency hand surgeries (2018-2024).
- Comparison between local anesthesia (including WALANT) and general/plexus anesthesia groups.
- Prospective definition of 'time to intervention' and postoperative complications as co-primary endpoints.
Main Results:
- Mean 'time to intervention' was 2.2 hours for local anesthesia vs. 4.1 hours for general/plexus anesthesia.
- Postoperative complication rates were similar: 8.5% (LA) vs. 8.2% (general/plexus).
- WALANT demonstrated a lower complication rate (5.7%) than local anesthesia without epinephrine (9.8%).
Conclusions:
- WALANT significantly reduces treatment time for emergency hand surgery.
- The safety profile of WALANT is comparable to general/plexus anesthesia.
- WALANT is a time-efficient and safe option for emergency hand surgery, supporting wider adoption.
