Wide-Awake Local Anesthesia No Tourniquet for Hand and Wrist Procedures: A Narrative Review of Current Concepts and Evidence
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Abstract
Wide-awake local anesthesia no tourniquet (WALANT) has emerged as an important anesthetic and surgical approach in hand and upper extremity surgery. By combining local anesthetic with epinephrine, WALANT enables procedures to be performed without sedation or tourniquet while allowing intraoperative communication and functional assessment. Beyond its anesthetic role, this technique has implications for surgical precision, patient-centered care, training environments, and health-system efficiency. This narrative review synthesizes current evidence and expert perspectives on WALANT, with emphasis on common procedures, expanding indications (e.g., fracture fixation and tendon repair), patient selection, safety considerations, and economic impact in urban healthcare settings. Available evidence indicates that WALANT achieves clinical outcomes comparable to those of conventional anesthesia techniques, with favorable patient-reported experiences, shorter recovery times, and reduced resource utilization. WALANT may be considered a suitable first-line option for selected upper extremity procedures when applied in appropriately chosen patients.
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