Wide awake local anesthesia no tourniquet in hand surgery: an analysis of adverse events and complications

Andrzej Żyluk


Introduction: Anesthesiologist’s assistance is considered an inseparable part of most surgical procedures, except for minor operations performed under local anesthesia. In hand surgery, most of the operations can be performed under regional (brachial plexus block) or local (infiltration) anesthesia. These procedures can be carried out by the surgeons themselves, which allows them to operate without the assistance of an anesthesiologist.
The objective of this study was an analysis of the efficacy and safety of anesthesia to operations in hand surgery performed by surgeons, without the assistance of anesthesiologists.
Materials and Methods: This analysis was based on records of anesthesia protocols completed by the surgeons who performed the procedure and who operated on the patients. The following variables were considered: efficacy of anesthesia, adverse effects associated with anesthesia and complications.
Results: Over a 10-year period (2013–2022), a total of 16,583 procedures were performed, of which 5638 (34%) were carried out under anesthesia by surgeons, without the assistance of anesthesiologists.
The efficacy of these procedures (local and brachial plexus blocks) was 98%. A total of 203 (3.6%) anesthesia-related events were noted, most of which were transient, requiring emergency intervention and without serious consequences. In only 12 cases (0.02%) adverse effects led to cancellation and postponement of the planned operation.
Conclusion: Anesthesia for operations in hand surgery performed by surgeons themselves and without the assistance of anesthesiologists is effective and safe and is associated with numerous benefits for patients, surgeons, and the budget of the medical care system.


hand surgery; regional anesthesia; brachial plexus block; WALANT anesthesia

Full Text:



Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Surg 2013;21(8):443-7.

Lalonde D. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur 2017;42(9):886-95.

Lalonde D, Bell M, Benoit P, Sparkes G, Denkler KA, Chang PS. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: The Dalhousie Project clinical phase. J Hand Surg Am 2005;30(5):1061-7.

Żyluk A, Szlosser Z. Local infiltration anaesthesia with a bloodless operative field (WALANT). Presentation of the technique and its use in hand surgery. Ortop Traumatol Rehabil 2020;22(3):203-9.

Sim WP, Ng HJ, Tan S, Bajaj SL, Rajaratnam V. Scope of hand surgery using surgeon administered local/regional anaesthesia. Ann Plast Surg 2019;83(3):278-84.

Abdullah S, Hua LC, Sheau YL, Thavamany Devapitchai AS, Ahmad AA, Narin Singh PS, et al. A review of 1073 cases of wide-awake-local-anaesthesia-no-tourniquet (WALANT) in Finger and Hand Surgeries in an Urban Hospital in Malaysia. Cureus 2021;13(7):e16269.

Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake local anesthesia with no tourniquet: an updated review. Plast Reconstr Surg Glob Open 2021;9(3):e3507.

Sardenberg T, Ribak S, Colenci R, de Campos RB, Varanda D, Cortopassi AC. 488 hand surgeries with local anesthesia with epinephrine, without a tourniquet, without sedation, and without an anesthesiologist. Rev Bras Ortop 2018;53(3):281-6.

Connors KM, Guerra SM, Koehler SM. Current evidence involving WALANT surgery. J Hand Surg Glob Online 2022;4(6):452-5.

Ince I, Aksoy M, Celik M. Can we perform distal nerve block instead of brachial plexus nerve block under ultrasound guidance for hand surgery? Eurasian J Med 2016;48(3):167-71.

DOI: https://doi.org/10.21164/pomjlifesci.950

Copyright (c) 2024 Andrzej Żyluk

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/