The term WALANT (Wide Awake Local Anesthesia No Tourniquet) refers to a new local anesthesia technique used for the surgical treatment of several common pathologies of the hand and wrist.
This technique, which was described and popularized thanks to Canadian Surgeon Dr. Don Lalonde’s expertise offers several significant advantages, including greater precision of the surgical gesture, a reduction in the discomfort, risks and adverse effects associated with anesthetics and faster recovery.
The surgeon administers a combination of drugs locally. The anesthetic action of lidocaine combined with the vasoconstrictive action of epinephrine (adrenaline) allows the surgeon to operate on a fully awake patient without putting a tourniquet in place, according to the conventional method. Once the drugs take effect, about 30 minutes after the infiltration, the surgeon can proceed with the incision and the operation. With the patient awake, he/she can follow the progress of the procedure and continue to move his/her fingers and hand at the surgeon’s request. This procedure allows the surgeon to observe the joint, the repaired tendon, or the implant (depending on the type of procedure) as needed. The absence of bleeding also makes it possible to visualize all the subtleties of the exposed structure. This results in better precision of the surgical procedure.
LOCAL ANESTHESIA
This method helps avoid the discomfort, complications, and side effects associated with intravenous anesthetic drugs or regional anesthesia (axillary block). A pain reliever can be offered to the patient if necessary.
SIMPLIFICATION OF THE PREOPERATIVE PROTOCOL
Since local anesthesia is much safer than general or regional anesthesia, preoperative examinations such as the traditional blood test and the electrocardiogram are no longer required. This greatly facilitates the patient assessment process.
ELIMINATES THE NEED TO FAST BEFORE THE PROCEDURE
As with a dentist’s visit, the patient can eat breakfast normally, as fasting is no longer necessary. This helps to avoid the discomforts associated with fasting and hypoglycemia.
BETTER SURGICAL PRECISION
The limitation of bleeding and the collaborative state of the patient allow greater surgical precision. Technical adjustments can be made during surgery, which ensures better results. Also, since the patient can see his hand moving, he can participate more actively in his rehabilitation.
IT DOES NOT INDUCE SENSORY OR MOTOR PARALYSIS
The WALANT technique does not induce motor or sensory paralysis. It prevents the patient’s arm from hanging loose and uncontrolled for several hours, as is the case with complete anesthesia of the upper limb.
BETTER COMFORT FOR THE PATIENT
The “wideawake” method avoids all the inconveniences associated with regional or general anesthesia, mainly preoperative fasting as well as nausea and fatigue often associated with stronger sedation.
REDUCTION OF POSTOPERATIVE PAIN AND SWELLING
The pain, swelling, and edema associated with the tourniquet and intravenous injections are spared. Recovery and return to normal activities are thus made more quickly.
REDUCED RISK OF COMPLICATIONS AND SIDE EFFECTS
Comparison of methods has shown a reduction in the risk of complications.
COST REDUCTION
The simplification of the surgical protocol, both in terms of steps, time, and resources, reduces the procedure’s costs and makes it more affordable for the patient. Dr. Brutus was among the first surgeons in the world to integrate this method into his daily practice. He uses this technique in particular to treat ligament tears, tendon lacerations, nerve compressions, osteoarthritis of the base of the thumb.
