Wide Awake Hand Surgery (WALANT)
Most hand, wrist, and finger surgery no longer requires general anesthesia. WALANT — Wide Awake Local Anesthesia No Tourniquet — is safer, faster to recover from, and allows you to actively participate in your own surgery.
What Is WALANT Surgery?
WALANT (Wide Awake Local Anesthesia No Tourniquet) is a technique pioneered by Dr. Donald Lalonde and now used by leading hand surgeons worldwide. The surgical area is numbed with a dilute solution of lidocaine (local anesthetic) and epinephrine (which controls bleeding by constricting small blood vessels — replacing the need for a tourniquet). This provides complete, long-lasting numbness without a tourniquet and without general anesthesia.
You remain awake throughout the procedure. The hand is completely numb — you feel pressure and movement but no pain. Most patients are surprised by how comfortable and calm the experience is — very similar to having dental work done.
ⓘ Comparable to dental anesthesia. The local injection is the most uncomfortable part. After that, the procedure is pressure and movement — no pain. Most patients find it far more comfortable than expected.
Advantages of WALANT
No General Anesthesia Risk
No nausea, vomiting, confusion, or rare anesthesia complications. Safe for elderly and medically complex patients who cannot tolerate general anesthesia.
No Tourniquet Pain
Traditional surgery uses a tourniquet causing significant arm aching. WALANT's epinephrine replaces the tourniquet entirely — no tourniquet discomfort.
Active Participation
Dr. Chambers can ask you to actively move fingers or tendons during surgery — providing real-time feedback on repair quality impossible under general anesthesia.
Faster Recovery
No post-anesthesia recovery room time, no grogginess or nausea. Many patients are ready to leave within an hour of the procedure ending.
Procedures Performed with WALANT
- Carpal tunnel release (endoscopic and open)
- Trigger finger release
- De Quervain's release
- Dupuytren's contracture release
- Tendon repair and reconstruction
- Ganglion cyst excision
- Cubital tunnel release
- Finger fracture pinning
- Many other hand, wrist, and finger procedures
What to Expect on Surgery Day
- Arrive at the surgery center — fasting requirements are minimal for pure local anesthesia cases
- Local anesthetic injected into the surgical area — 5–10 minutes; this is the most uncomfortable part
- Anesthetic takes effect over 20–30 minutes while you wait comfortably
- Surgery performed while you listen to music or chat with Dr. Chambers and the team
- Leave the facility shortly after — no recovery room wait
⚠ Some facilities charge differently for WALANT vs. general anesthesia. WALANT is generally less expensive — check with your insurance and the surgery center about any cost differences before your surgery date.
Frequently Asked Questions
No — the surgical area is completely numb. You will feel pressure, movement, and tapping — but no pain. The local anesthetic injection at the start is the most uncomfortable part. Most patients describe the overall experience as surprisingly comfortable and much better than expected.
Many patients who are initially anxious find the experience much better than expected. You can listen to music, close your eyes, or talk with Dr. Chambers throughout. A small dose of oral anxiolytic medication can be given before surgery if needed. If anxiety is severe, sedation can be added.
Fasting requirements for pure WALANT procedures (no sedation) are typically minimal — often a light meal is permitted. However, follow the specific instructions provided by Dr. Chambers's office and the surgery center, as requirements vary by facility and procedure. If sedation is planned, full fasting instructions apply.
Related Conditions & Resources
Questions About WALANT Surgery?
Dr. Chambers will discuss anesthesia options at your consultation. No referral needed.
Stephen Chambers, M.D.
Dual Board-Certified Hand & Upper Extremity Surgeon · Raleigh Orthopaedic