WALANT in Hand Trauma Surgery: Safety and Efficacy

Abstract

Background: This study evaluates the time efficiency and safety of Wide Awake Local Anesthesia No Tourniquet (WALANT) compared to general/plexus anesthesia in emergency hand surgery. Methods: This single-center, retrospective study analyzed 812 emergency category 2b hand surgeries performed between 2018 and 2024. Patients were divided into 2 groups: local anesthesia (LA), including WALANT, and general/plexus anesthesia. In collaboration with the Institute for Medical Statistics and Biometry, “time to intervention” and postoperative surgical complications were prospectively defined as co-primary endpoints. In addition, a descriptive analysis of the study population was conducted, and a matched-pair analysis was performed to account for injury complexity. Statistical analysis included t-tests, Cohen’s d, and Gart and Nam’s method for risk difference. Results: The mean “time to intervention” was significantly shorter in the LA group (2.2 hours) compared to that in the general/plexus anesthesia group (4.1 hours). Postoperative surgical complication rates were comparable between the LA (8.5%) and general/plexus anesthesia (8.2%) groups, with no significant difference observed. WALANT showed a lower complication rate (5.7%) than LA without epinephrine (9.8%). A matched-pair analysis confirmed these findings. Among the general/plexus anesthesia cases, 16.2% exceeded the recommended 6-hour treatment window, compared to 6.6% in the LA group. Conclusions: Wide Awake Local Anesthesia No Tourniquet facilitates faster treatment of emergency hand surgery cases while maintaining equivalent quality of care compared to general/plexus anesthesia. This study highlights the time efficiency and safety of WALANT in emergency settings, supporting its broader application.