Facilitators, Barriers and Reported Implementation Outcomes of Wide-Awake Local Anaesthesia No Tourniquet in Hand...

Wide-Awake Local Anaesthesia No Tourniquet (WALANT) is increasingly being used by hand surgeons. This systematic scoping review aims to identify and collate existing evidence on the reported implementation outcomes, barriers, facilitators and implementation strategies relevant to WALANT in hand surgery practice.

A systematic search was conducted across major medical databases as well as grey literature from inception to 13 February 2025. Studies were included if they reported on implementation outcomes, implementation strategies and/or the perspectives and experiences of clinicians, patients and other stakeholders. Included records were independently reviewed, with the data extracted and analysed narratively.

Forty-five studies were included: mostly observational, orthopaedic-focused, hospital-based, from North America and Europe. The evidence base was dominated by the outcomes of acceptability and cost, with little or no explicit reporting of feasibility, adoption, or penetration. Common barriers included patient anxiety, lack of knowledge and training, persistent misconceptions about safety, departmental and anaesthetist attitudes and limited resources. Key facilitators included positive patient experiences and feedback, the presence of surgical and departmental champions, educational resources and cost savings. Strategies assisting uptake included patient education, financial incentives and dedicated WALANT facilities.

WALANT implementation in hand surgery is influenced by a combination of perceived advantages, organisational and system-level conditions, individual knowledge and beliefs and the presence of supportive champions and leadership. Future research should more explicitly evaluate how WALANT is implemented, sustained and scaled across different health care contexts.