A radical innovative change in the practice of hand surgery using wide awake local anesthesia

Wide-awake local anesthesia no tourniquet (WALANT) technique is characterized by using local anesthetic plus adrenaline administered into the operative field, enabling us to perform longer and complex hand procedures without the need of an anesthetist. We assessed the impact of integrating WALANT on the practice of hand surgery in our center. We retrospectively reviewed charts of all hand surgeries performed in the years 2011 and 2016. The number of trauma cases performed in the ambulatory OR increased from 56 cases in 2011 to 131 in 2016, and elective complex cases increased from 9 to 65. Number of elective procedures conducted in the main OR increased from 67 to 105, and trauma cases performed "off hours"decreased from 53 to 21. We conclude that WALANT enables us to better utilize our OR resources, to treat hand trauma patients on an outpatient basis, and to shorten the wait time for elective hand surgery.