So...here 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.
Adrenaline
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.
I want to thank Alistair Phillips of England for creating this web site. He is an angel to all of the patients who will now benefit from safer, easier, less expensive surgery with the elimination of the tourniquet and sedation!
This extremely valuable resource will be so helpful to all surgeons and therapists who are interested in the technique!
There is a great deal of international interest in wide awake hand surgery. In addition to more than a dozen American cities, over the last 2 years, I have been invited to speak in:
1. The Icelandic Hand Surgery Society, Reykjavik, Iceland, January 26, 2018.
2. The French Society for Surgery of the Hand, Paris, France, December 19, 2017.
3. Asia Pacific Federation of Societies for Surgery of the Hand, Cebu, Philippines, November 10, 2017.
4. Italian Society for Hand Surgery, Modena, Italy, October 14, 2017.
5. Central Japan Association of Orthopedic Surgery and Traumatology, Toyama, Japan, October 6, 2017
6. Federation of European Societies for Surgery of the Hand, Budapest, Hungary, June 23, 2017.
7. International Orthopedic Congress, Dubai, United Arab Emirates, May 19, 2017.
8. Brazilian Society for Hand Surgery, Belo Horizonte, Brazil, April 1, 2017.
9. Korean Society for Surgery of the Hand, Seoul, Korea, November 12, 2016 (spoke in 4 cities in Korea).
10. International Federation of Societies for Hand Surgery, Buenos Aires, Argentina, October 26, 2016.
11. German Society for Surgery of the Hand, Frankfurt, Germany, September 23, 2016.
12. Trauma and Emergency Grand Rounds, Kumasi, Ghana, September 8, 2016.
13. Federation of European Societies for Surgery of the Hand, Santander, Spain, June 22, 2016.
14. Australian Society of Plastic Surgeons, Brisbane, Australia, May 5, 2016. (spoke in 5 cities in Australia)
Surgeons all over the world have been generous with sharing WALANT knowledge. I am grateful to all of you.
Don Lalonde