Wide Awake Hand Surgery (WALANT)

What is WALANT?

Wide awake hand surgery or WALANT (Wide Awake Local Anaesthetic No Tourniquet) is the use of a local anaesthetic combined with adrenaline, injection techniques which are well tolerated by patients. The end results is to provide a focused numbing of the skin and deeper tissues, including bone, whilst causing a constriction of blood vessels that minimize bleeding. This allows the patient to remain awake whilst not feeling any sharp or painful feelings during the operation, without the need for a tourniquet (blood pressure type cuff)to prevent bleeding and also allowing your involvement with active movement of the hand and fingers, when required by the surgeon.

What operations can be done using wide awake techniques?

Common operations that can be performed under Wide awake surgery include:

  • Carpal tunnel release
  • Trigger finger surgery
  • Finger fracture fixation

The advantages of this technique allow the patient to recover quickly from their anaesthetic to minimise their risk of exposure to general anaesthesia or sedative drugs that can interact with other medications, cause drowsiness or other adverse reactions. Elderly patients who may have heart or lung conditions or on bleeding medications are well suited to this technique as are young active patients who want to get back to their busy routines, coming in and out of hospital quickly without any medication hangover effect.

What are the advantages of wide awake surgery?

The advantages in this technique, are that the surgeon can fine tune their surgery whilst you provide immediate feedback as to how you feel your hand moves and functions on the operating table.   The ability to refine the balance the intricate structures that have been repaired in the hand and match your expectations in real time is of benefit. It is an opportunity for you to be involved in your surgery (you do not have to watch!). The memory of seeing your hand move on the operating table continues to motivate you when you participate in hand therapy in the recovery period, especially if or when the road gets tough!

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Dr Avanthi Mandaleson

Specialist Hand & Upper Limb Surgeon​
(BMedSci, MBBS, FRACS, FAOrthA)

For all appointments please call (03) 9456 9077