Introducing WALANT

WALANT is Wide Awake Local Anesthesia, No Tourniquet and describes the way we’re able to do surgeries in an office with only local numbing medication. The credit for developing this process goes to several folks over the last few decades, especially Canadian hand surgeon Dr. Don Lalonde.

Numbing medicines

Multiple types of numbing medication are used.

  • Lidocaine: a numbing medicine that works for fast-acting pain control
  • Epinephrine: to help control bleeding
  • Bupivacaine: longer-acting numbing medication

When they are mixed together, injected locally and given the right amount of time to take effect, a small area is anesthetized with bleeding control so small procedures such as carpal tunnel release or trigger finger release can be done in the office.

Types of procedures

We can do most procedures where the hand or finger can be numbed and we can safely do a case. In an office setting, the patient is laying down relaxed and surgery is being performed.

The most common procedures performed are

  • Carpal tunnel releases;
  • Trigger finger releases;
  • Thumb tendonitis releases;
  • Cyst excisions (e.g. for ganglion cysts);
  • Foreign bodies that can be removed; or
  • Other masses to be removed

Why use WALANT?

WALANT is done in the same way you go to a dermatologist or dentist’s office.

  • No preoperative testing or fasting
  • No medical clearance needed because medicine is not changed
  • No IV
  • Shorter surgical time because there are fewer steps
  • Significant face-to-face time between surgeon and patient
  • Less expensive, without facility fees or anesthesia fees
  • Less time in the recovery room
  • Able to drive yourself both ways

What about the needles?

Some people don’t like needles and the idea of injecting local anesthesia can be scary. Dr. Lalonde’s book on WALANT surgery includes a chapter dedicated to injecting local anesthesia without pain, and the needle used for the local anesthesia is much smaller and less painful than the typical IV needle used in a hospital.

Is WALANT safe?

Doctors have performed multiple studies on thousands of patients all over the world, including the US and Canada, that show WALANT is safe and preferred by many patients.

However, there are certain patients where WALANT may not be the best choice.

Patients who should avoid WALANT include those who:

  • Have severe circulation, bleeding, or clotting problems;
  • Are allergic to lidocaine; or,
  • Do not want to be awake for surgery.

How is WALANT performed?

WALANT takes place in a traditional office setting in a regular clinic room. There is much less equipment used and much less waste. The patient is in street clothes and can choose to watch or not watch the procedure.

I appreciate being able to communicate with the patient directly, including preoperative teaching to show them exactly what I’m seeing if they’re interested, and to review post-operative expectations so we can have an optimal outcome.

Patient Reaction to WALANT

In every study about WALANT surgery, nine out of ten patients would do it again. They prefer in-office surgery over a standard operating room and they would recommend it to friends and family. The average pain score on a scale of 1 to 10 is 0.2. Patients have significantly higher satisfaction and overall decreased anxiety with office-based procedures versus a main operating room.

Frequently Asked Questions

How long does the procedure itself take?

It depends on the type of procedure being performed. A carpal tunnel release or trigger finger release may take as little as 10 minutes of actual surgery after the local anesthetic starts to work. Most patients spend less than five minutes in the post-operative recovery area, where snacks are available, before driving themselves home.

Are the post-operative restrictions the same after WALANT as after a traditional method?

Yes, the post-operative restrictions are the same. From a surgical standpoint, all of the procedural steps I take are the same.

How long does the local anesthesia work? Is your hand numb for the rest of the day?

We use two different local numbing agents. Lidocaine is short acting, working within a few minutes and lasts from 30 minutes to up to two hours. The longer acting numbing medication I use is for post-operative pain control and may last several hours after surgery.

Your hand is not numb the entire time. You have full motion of your fingers, which helps in surgeries such as a trigger finger release where I can check there is no further triggering or locking.

Can you treat two conditions at once with WALANT?

Yes, you can. We often treat two conditions as once, such as carpal tunnel releases with trigger finger releases, or a ganglion cyst in addition to your carpal tunnel.

If you’ve had a cortisone shot, can you have this technique?

The restrictions for cortisone are the same. We wait several weeks, up to three months, from your last cortisone injection before you’re able to have surgery like a trigger finger release or a carpal tunnel release.

Are all of these procedures ultrasound guided?

The ultrasound guidance is used primarily for procedures that are minimally invasive or percutaneous (through the skin). The utility of the ultrasound helps me to see important structures that are underneath the skin without having to make an incision for procedures such as tennis elbow procedures or trigger finger procedures. An ultrasound is not necessary when there is an open incision, such as for a carpal tunnel release or a De Quervain’s release, because you’re able to see the important structures underneath.