The technique, known as WALANT (wide-awake local anaesthesia, no tourniquet), enables surgeons to perform many procedures in a relatively pain-free manner, without the need for general anaesthesia.

The WALANT system uses local anaesthetic mixed with adrenaline to cause vasoconstriction, which reduces bleeding and avoids the need for a painful tourniquet which is a device that applies pressure to a limb or extremity so as to limit – but not stop – the flow of blood.

Historically, surgeons were all taught to avoid the use of adrenaline in end arteries, such as the fingers, for fear of 'digital ischaemia' and eventual finger loss. However, current clinical evidence does not support this view and the adverse effects of adrenaline can be rapidly reversed using phentolamine.

While it may sound alarming to be fully conscious when you go under a surgeon’s knife, there are many benefits for both patients and surgeons. OrthTeam Hand and Wrist Consultant, Mr Mike Hayton, explains:

Advantages to the patient:

• Avoidance of a general anaesthetic with all its associated risks and side effects including nausea, grogginess and thromboembolic disease (DVT, PE) 
• Post-operative controlled pain as there is no tourniquet used during surgery, the majority of patients will experience minimal pain following surgery
• Rapid discharge means that patients are free to leave the hospital once back from theatre. On average, this saves the usual three to four hour recovery period before going home
• Real-time feedback to the surgeon during the operation. The patient will understand the surgery and can even watch the procedure and will therefore know what exactly has been done, which could help them with post-operative rehabilitation

Advantages to the surgeon:

There are significant benefits for the surgeon with the technique being more dynamic than standard methods, allowing them to interact with the patient and the tissue which is being operated on while the procedure is taking place. This is particularly important for surgery that involves obtaining movement as an outcome.

There are a number of common procedures where WALANT can be applied including:

• Finger joint replacements can be inserted and the stability and range of movement assessed with active movement on the table to ensure adequate soft tissue balance and movement is achieved. If the joint feels stiff, then further bone resection can be performed and the movement then reassessed and improved
• Tendon transfers performed with the patient asleep are often difficult to gauge tension in the reconstruction. With wide-awake feedback from the patient, the perfect tensioning can be obtained by movement of the joints. If inadequate tension has been created, the transfer can be tightened to optimise function
• Acute tendon repairs in particular benefit from this technique. The repair can be done under active (rather than passive) load and assessed for gapping which is known to lead to early rupture. Active movement can also identify catching of the repair through the narrow fibrosseous tunnels in the hand and wrist. In such cases the repair is tidied up with small buried sutures to create a smooth repair site

WALANT is a very powerful tool that is safe, effective and well tolerated by patients. It has become a major method of providing anaesthesia and its use is ever-widening to currently include trapeziectomies and wrist arthroscopy. 

Mr Hayton is very experienced in the technique and the majority of his patients, that are suitable, undergo this method. He perfected this technique from Don Lalonde a hand surgeon from Canada. He first saw the method demonstrated by Don when they were both the invited guest speakers at the American Association for Hand Surgery in 2011.

To book a consultation with Mr Hayton or for more information please call 0161 447 6888.

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