Wide Awake Local Anesthesia No Tourniquet in Orthopaedic Surgery

Introduction to wide awake local anesthesia no tourniquet technique (WALANT) at BONES 2024

2. 01
What is WALANT?
02
Advantage of Using WALANT
03
Anesthetic Agents Using in WALANT
04
Application of WALANT
05
Training and Practice
06
Practical Points
07
Case Example

3. What is WALANT?
WALANT, or Wide-Awake Local Anesthesia
No Tourniquet, is a technique used in hand
surgery that employs local anesthetics,
specifically lidocaine and epinephrine,
allowing patients to remain awake during
procedures. This method eliminates the need
for general anesthesia and tourniquets,
enhancing patient comfort and safety while
reducing costs and recovery time.

4. Advantages of Using WALANT
Avoids general anesthesia
Eliminates the need for tourniquets
Allows real-time intraoperative
assessment of tendon gliding and
range of motion
Reduces costs
Shortens procedure and recovery time
Provides a relatively bloodless surgical
field
Avoids risks of general anesthesia
Improves patient satisfaction

5. Anesthetic Agents
Using in WALANT
Lidocaine with 1:100,000 epinephrine
Safe dose: 7mg/kg, max. 500 mg
1% lidocaine with 1:100,000 epinephrine provides
up to 4hrs. of local anesthesia and vasoconstriction
Bupivacaine and ropivicaine are avoided, given
their higher potential for cardiotoxicity.

7. Application of WALANT
CTS, UTS
Trigger finger/DQ
Repair tendon/tendon
transfer
Local flap coverage
Distal radius fracture
etc.

8. Training and Practice
Understanding
Surgical
Indications
Volume
Calculations and
Infiltration
Technique
Patient and Team
Communication
Experience with
Local Anesthesia
Familiarity with
Complications

9. Practical Point

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