Category Archives for "General"


Welcome to Walant.Surgery we go!

Wide Awake Hand Surgery is not new. It has been used for decades. every time we use local anaesthetic (LA) exclusively to do an operation, we are performing "Wide Awake Hand Surgery". The reason why we have built this website is that WALANT is different.

Walant stands for Wide Awake Local Anaesthesia No Tourniquet. The clue is in the name! As opposed to simply injecting plain LA (e.g. 1% lidocaine), applying a tourniquet to give us a traditionally "dry" field and starting, the adrenaline added to the mixture negates the need for this tourniquet.

Ok, the field is now not "dry" but more like "moist", but the tissues themselves prefer to be moist don't they? There is a little bleeding / ooze initially but if you wait a while before starting (evidence for 1:100 000 adrenaline concentration suggests waiting 25 minutes before starting) the field is certainly easily manageable; you just get through more swabs.


It can take a little getting used to but have no fear, you will be able to see plenty well enough and 20 minutes into the operation, the field will be almost dry. I have injected 6 small cases consecutively and then taken two hours to get to the last one. It was the driest of them all!

The difference with Walant Surgery is that there is a cascade effect by adding adrenaline to the LA:

  • without a tourniquet, you don't need an anaesthetic team/room/machine to provide a regional or general anaesthetic for the tourniquet pain. This has obvious implications for cost and flow of patients let alone less injections for the patient.
  • Without an anaesthetic team your options for where you operate increase.
  • Combine it with field sterility and you have suddenly opened the door to much more cost effective, streamlined surgery in your office or minor ops room. 

See Why Walant for more in depth look at why it is a win for the patient, for us, for the healthcare economy and insurers.

We believe it should be part of all Hand Surgeons' armoury. Do you? Let us know in the comments below.