Wide Awake Hand Surgery


Many procedures in my practice can be performed with local anaesthesia alone. This avoids the use of sedation or general anaesthesia. This technique — known as Wide-Awake Local Anaesthesia, No Tourniquet (WALANT) is particularly useful for procedures such as tendon repair, carpal tunnel release, trigger finger release or mass removal.

The key to performing WALANT surgery is lidocaine with epinephrine. Lidocaine is the same drug that dentists use in their office to control pain. With enough lidocaine procedures can be performed without the patient experiencing any pain. When we mix epinephrine with the lidocaine the pain relief lasts even longer, and the epinephrine constricts the surrounding blood vessels and thus controls bleeding. Because there is very little bleeding, we don't need to use a tourniquet which is often uncomfortable for the patient.

Wide Awake Trigger Finger Release

Benefits of WALANT surgery:

  • No sedation means no side effects from general anaesthesia.
    (No Nausea. No headache. No sore throat. No itching. No fogginess. NOTHING!)
  • Patients go home more quickly after surgery.
  • Patients do not have to stop blood thinners before surgery.
  • Patients with medical problems that might preclude them from an operation can have WALANT surgery.
  • For tendon surgery, patients can participate in the operation. This allows me to perfectly tension the repaired tendon.
  • For trigger finger surgery patients participate by flexing the finger down allowing me to see that the tendon is completely released.
  • Patients are more engaged in their own care. We use the time in the OR to teach patients about their procedure and the anatomy.
  • WALANT procedures can be performed with significantly decreased costs.
  • WALANT procedures can be performed with decreased medical waste.

Procedures I perform using WALANT anesthesia:

  • Carpal tunnel release
  • Tendon Transfer Surgery
  • Tendon repair
  • Removal of scar tissue for stiff fingers or joints
  • Trigger finger release
  • Ganglion or mass removal
  • Joint replacement surgery
  • Dupuytren's contracture release
  • Fracture stabilization procedures
  • Nerve repair surgery

Come speak with us regarding doing your hand procedure using our wide awake hand surgery techniques. WALANT is not for everyone. Some patients are more comfortable being asleep for their procedure. Others prefer some light sedation in addition to the lidocaine. Both of these options are perfectly fine as well, and offer some patients the "best of both worlds."