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What's New in Wide-Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery?
Steven M Koehler1, Egemen Ayhan2
1Department of Orthopaedic Surgery, Montefiore Einstein, Bronx, NY.
Journal of Hand Surgery Global Online
|May 25, 2026
Summary
Wide-awake local anesthesia no tourniquet (WALANT) offers comparable outcomes to traditional anesthesia in hand surgery. This evidence-based approach enhances patient satisfaction, reduces costs, and minimizes environmental impact.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Evidence-Based Medicine
Background:
- Wide-awake local anesthesia no tourniquet (WALANT) is increasingly adopted in hand surgery.
- Post-COVID-19 literature expansion necessitates evidence synthesis for clinical practice.
Purpose of the Study:
- To review and synthesize contemporary evidence on WALANT across key domains.
- To guide clinical practice by evaluating WALANT's efficacy, safety, and impact.
Main Methods:
- Narrative review of recent WALANT studies.
- Thematic organization into comparative trials, pediatric use, patient satisfaction, environmental impact, cost, and expanded applications.
Main Results:
- WALANT shows noninferior functional outcomes and complication rates versus traditional anesthesia.
- High patient satisfaction, improved intraoperative pain, and similar early postoperative pain are reported.
- WALANT reduces waste and emissions, offers cost savings, and is expanding to new procedures.
Conclusions:
- WALANT is a mature, evidence-supported pathway aligning outcomes, patient experience, sustainability, and cost-efficiency.
- Optimal impact requires integration into procedure room workflows with careful patient selection and technique.
- Future work should refine indications, optimize patient experience, and scale implementation.
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