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WALANT hand surgery
Wide Awake Local Anaesthetic, No Tourniquet
Many common hand procedures can be performed while you are fully awake, using local anaesthetic alone — no general anaesthetic, no sedation, and no tourniquet. This approach is known as WALANT, and it’s how Dr Tomlinson performs several of her most common procedures.
What is WALANT?
WALANT stands for Wide Awake Local Anaesthetic No Tourniquet. It’s a technique for hand surgery that uses a local anaesthetic injection containing a small amount of adrenaline (epinephrine) to numb the area and control bleeding — removing the need for a tourniquet, sedation or a general anaesthetic.
The technique was first formally described by Canadian hand surgeon Dr Donald Lalonde in 2005 and has since become widely used for hand surgery internationally, including in Australia.
How does WALANT work?
Before your procedure, Dr Tomlinson injects a local anaesthetic solution – typically xylocaine or bupivacaine combined with a low dose of adrenaline – into the area being operated on. The adrenaline constricts small blood vessels, keeping the surgical field clear of bleeding without needing a tourniquet, while the xylocaine or bupivacaine numbs the area completely.
The injection is given before surgery starts, to give both the numbing and the bleeding control time to take effect.
Is the adrenaline safe in my fingers?
Yes, it is. There was historically a belief that adrenaline should never be injected into fingers, out of concern it could cut off blood supply to the digit. This has since been shown to be unfounded: a review of accidental high-dose adrenaline injection into fingers found no cases of tissue loss, and adrenaline at the low concentration used in WALANT has been used safely in thousands of digits without lasting harm.
Your finger may look pale for a short time after the injection as the blood vessels constrict. This is expected, temporary, and resolves on its own within minutes.
What does it feel like?
You’ll be awake throughout your procedure. The anaesthetic injection itself causes a brief sting, similar to a dental injection, after which the area goes numb. During surgery you may feel pressure or a sense that something is happening, but you should not feel pain – if you do, tell Dr Tomlinson and more anaesthetic can be given.
For some procedures, Dr Tomlinson may ask you to move your finger or hand during surgery. This is particularly useful in tendon-related procedures such as trigger finger release, where it lets her confirm the tendon is gliding properly before you leave theatre.
Benefits of WALANT
- No general anaesthetic or sedation, and none of the risks or recovery time that come with them
- No fasting required beforehand — you can eat and drink normally
- No tourniquet, which some patients find uncomfortable
- Usually a faster recovery, with same-day discharge
- You can go home alone via taxi or rideshare or public transport, if you choose
- Often more convenient and less expensive than a procedure requiring an anaesthetist
- For tendon procedures, lets Dr Tomlinson check your hand is working properly with you awake, before you leave theatre
Procedures Dr Tomlinson performs under WALANT
Dr Tomlinson regularly performs the following procedures using WALANT:
Open carpal tunnel release
Surgery to relieve pressure on the median nerve at the wrist, for carpal tunnel syndrome. Learn more about open carpal tunnel release.
Trigger thumb and trigger finger release
Surgery to free a flexor tendon that catches or locks at the base of the finger or thumb. Learn more about trigger thumb and trigger finger release.
Excision of digital mucous cysts
Removal of a small cyst near the fingernail, usually arising in association with osteoarthritis of the joint closest to the fingertip (the DIP joint). Learn more about excision of digital mucous cysts.
Excision of finger ganglions
Removal of a ganglion cyst arising from the flexor tendon sheath at the base of the finger. Learn more about excision of finger ganglions.
Is WALANT right for me?
Most patients having these procedures are suitable for WALANT, and Dr Tomlinson will discuss whether it’s the right choice for you at your consultation. If you would prefer to be asleep or sedated instead, that option remains available.
Frequently Asked Questions
Will I be awake for my whole procedure?
Yes. You’ll be awake and alert throughout, able to talk with Dr Tomlinson and the theatre team.
Do I need to fast beforehand?
No. If your procedure is performed under WALANT only, fasting is generally not required – you can eat and drink normally beforehand.
Can I choose to be asleep or sedated instead?
Yes. WALANT is a common method used by Dr Tomlinson, but sedation or a general anaesthetic remain available if you would prefer them – this will be discussed at your consultation.
How long does the numbness last?
The duration of action of local anaesthetic varies considerably depending on whether it is “short acting” or “long acting”.
Short acting local anaesthetic often lasts 1-2 hours.
Long acting local anaesthetic generally lasts 6–24 hours, during which the treated area will feel numb. Occasionally it lasts as long as 72 hours in some individuals.
When can I drive afterwards?
Plan not to drive for 2 weeks after open carpal tunnel release, or 1 week after trigger thumb and trigger finger release. Driving guidance after digital mucous cyst excision or finger ganglion excision varies by patient – Dr Tomlinson will advise you at your consultation.
Risks specific to the WALANT technique
Procedure-specific risks (e.g. nerve or tendon injury for a given operation) are covered on each procedure’s own page, not duplicated here. The risks below relate to the anaesthetic technique itself.
- Allergic reaction to the local anaesthetic (rare)
- Bruising or bleeding at the injection site
- Discomfort from the injection itself
- Temporary blanching (whitening) of the finger from the adrenaline, which resolves on its own
- Rarely, the block does not fully numb the area, requiring more local anaesthetic or, occasionally, conversion to sedation or a general anaesthetic
Next steps
Want to know more about WALANT hand surgery? Contact us to schedule an appointment with Dr Tomlinson.
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.