Retrospective Evaluation of WALANT in Upper Extremity Procedures: Surgical Outcomes and Patient Satisfaction

Aim: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is gaining popularity as an alternative to traditional anesthesia methods in upper extremity surgical procedures. WALANT, which eliminates the need for a tourniquet, also has advantages such as reduced cost, increased patient satisfaction, and intraoperative functional evaluation. This study aims to evaluate the surgical outcomes, intraoperative pain, and patient satisfaction in a diverse range of upper extremity procedures performed using WALANT. Methods: A retrospective review was conducted on 218 patients who underwent upper extremity surgery using the WALANT technique. Surgical procedures included trigger finger release (n=75), carpal tunnel release (n=65), tendon transfer (n=8), finger fracture fixation (n=34), metacarpal open reduction and internal fixation (ORIF) (n=7), scaphoid fracture fixation (n=2), and flexor tendon repair (n=27). The primary outcomes assessed were surgical time, intraoperative pain (Visual Analog Scale, VAS 0-10), postoperative complications, and patient satisfaction (5-point Likert scale). Results: The mean intraoperative pain score was 1.6 0.9, with minimal discomfort reported across all procedures. The average surgical time varied depending on the procedure, with trigger finger release being the shortest (17.4 4.2 minutes) and tendon transfers the longest (52.6 8.9 minutes). The overall postoperative complication rate was 5.0%, with transient stiffness (3.2%) and delayed wound healing (1.8%) being the most common. Infection occurred in 0.9% of cases, all managed successfully with oral antibiotics. No patients required conversion to general anesthesia. Patient satisfaction was high, with a mean Likert score of 4.7 0.6, reflecting strong acceptance of the WALANT technique. Conclusion: WALANT is a safe and effective alternative to conventional anesthesia for upper extremity surgeries, providing adequate intraoperative analgesia, reducing complications, and achieving high patient satisfaction. Its ability to facilitate intraoperative functional assessment is particularly advantageous in tendon and fracture surgeries. Given its benefits, WALANT should be considered a preferred technique for a wide range of upper limb procedures.