Wide awake local anaesthesia no tourniquet technique (WALANT)

Abstract

Until recently most hand surgeries was performed with a tourniquet to provide better visibility. The discomfort of the tourniquet is very unpleasant and unnecessary for patients. To avoid this, we have traditionally relied on an anesthesiologist to give sedation, brachial plexus or Bier block, or general anesthesia. A good alternative to traditional tourniquet hand surgery is to use only 2 medications; lidocaine for anesthesia and epinephrine for hemostasis. Lidocaine and epinephrine are likely two of the safest and most widely tested drugs known to mankind. Billions of doses of these two medications have been injected into people for simple dental procedures in dental offices since 1950 with no preoperative testing, no monitoring, no intravenous insertion, and very few adverse events. Epinephrine in the finger is now known to be safe (Lalonde DH, Martin A. Epinephrine in local anesthesia in finger and hand surgery: The case for wide-awake anesthesia. J Am Acad Orthop Surg; 2013;21(8):443). Finger necrosis blamed on epinephrine before the1950s when the epinephrine myth was created is now known to have been caused by procaine. Like dental procedures, wide awake hand surgery can be performed with no preoperative testing, no intravenous insertion, and no monitoring. The patient simply gets up and goes home after the procedure.