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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(04): 531-537
DOI: 10.1055/s-0042-1748659
Hand/Peripheral Nerve
Review Article

WALANT: A Discussion of Indications, Impact, and Educational Requirements

Authors

  • Shahab Shahid 

    1   The Centre for Hand Surgery, St. Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, United Kingdom

  • Noman Saghir 

    2   Nightingale Breast Centre, Wythenshawe Hospital, Manchester, United Kingdom

  • Reyan Saghir 

    3   Department of Cardiology, Calderdale Royal Hospital, Halifax, United Kingdom

  • Quillan Young-Sing 

    1   The Centre for Hand Surgery, St. Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, United Kingdom

  • Benjamin H. Miranda 

    1   The Centre for Hand Surgery, St. Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Chelmsford, United Kingdom
    4   St Andrew&s Anglia Ruskin (StAAR) Research Group, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, United Kingdom

Funding None.
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Abstract

Wide-awake, local anesthesia, no tourniquet (WALANT) is a technique that removes the requirement for operations to be performed with a tourniquet, general/regional anesthesia, sedation or an anesthetist. We reviewed the WALANT literature with respect to the diverse indications and impact of WALANT to discuss the importance of future surgical curriculum integration. With appropriate patient selection, WALANT may be used effectively in upper and lower limb surgery; it is also a useful option for patients who are unsuitable for general/regional anesthesia. There is a growing body of evidence supporting the use of WALANT in more complex operations in both upper and lower limb surgery. WALANT is a safe, effective, and simple technique associated with equivalent or superior patient pain scores among other numerous clinical and cost benefits. Cost benefits derive from reduced requirements for theater/anesthetic personnel, space, equipment, time, and inpatient stay. The lack of a requirement for general anesthesia reduces aerosol generating procedures, for example, intubation/high-flow oxygen, hence patients and staff also benefit from the reduced potential for infection transmission. WALANT provides a relatively, but not entirely, bloodless surgical field. Training requirements include the surgical indications, volume calculations, infiltration technique, appropriate perioperative patient/team member communication, and specifics of each operation that need to be considered, for example, checking of active tendon glide versus venting of flexor tendon pulleys. WALANT offers significant clinical, economic, and operative safety advantages when compared with general/regional anesthesia. Key challenges include careful patient selection and the comprehensive training of future surgeons to perform the technique safely.

Keywords

WALANT - wide awake hand surgery - local anesthesia no tourniquet - education - training - simulation

Author Contributions

Conceptualization: S.S. and B.H.M. Funding and Acquisition: Not applicable. Methodology: S.S., N.S., R.S., Q.Y.S., B.H.M. Writing-original draft: S.S., N.S., R.S., Q.Y.S., B.H.M. Writing-review and editing: S.S. and B.H.M.




Publication History

Article published online:
30 July 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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