Wide-Awake Local Anesthesia No Tourniquet (WALANT) Technique for Atraumatic Hand Surgery: A Systematic Review and Meta-analysis .

Updated evidence from nine randomized trials sheds light on how WALANT compares with anesthesia using a tourniquet for atraumatic hand surgery. Across studies, prep time was consistently longer with WALANT because surgeons must wait for adrenaline to achieve optimal vasoconstriction, but once surgery began, the two approaches performed similarly. What stood out was pain: patients treated with WALANT reported meaningfully less discomfort during the operation and in the early postoperative hours. Beyond that, operative time, blood loss, injection pain, pain at one week, and complication rates showed no real differences. Most outcomes were backed by low-certainty evidence, but the findings support WALANT as a practical, comfortable option when minimizing intraoperative pain is a priority.