WALANT:
Wide Awake Local Anaesthetic no Tourniquet

What is WALANT?

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Many operations in hand surgery and foot surgery can be done with WALANT technique. This technique was developed by Don Lalonde, a Plastic Surgeon at Dalhousie University in Canada. Mr Robinson completed one oh his orthopaedic advanced fellowships at this university and has had the privilege of being advised by Dr Lalonde.

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• A mixture of local anaesthetic and adrenaline is used to provide pain control and prevent bleeding. Large volumes of the mixture are injected everywhere that needs to be anaesthetic during the case.

• Diluted adrenaline has been proven to be safe to inject into fingers. No anticoagulants need to be stopped pre-operatively.

• A wait of a minimum of 15 – 20 minutes from injection to incision for best effect is required. In fact, surgeons could wait up to 90-120 minutes before operating. ​

• Not having a tourniquet inflated removes any time constraint and also the pain that they cause. ​

• Pain relief may last from 4 hours up to 15 hours depending on the pain killing substance used in the mixture.​​

 

Contraindications for WALANT

• Allergy to any of the medicines used

• Problems with circulation

• Patient does not wish to be awake

• Anxious and non-compliant patients

• Paediatric cases

• Patient with infection at sites of injection

• Cardiac disease – consider diluting adrenaline 1:400 000

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