Welcome!
Wide Awake Hand Surgery
This technique eliminates the discomfort and risks associated with general and regional anaesthesia, tourniquet pain, and unnecessary hospital admission - making it ideal for a day-surgery setting.
​My Approach
WALANT (Wide Awake Local Anaesthesia No Tourniquet) represents a major shift in how modern hand surgery is performed.
Instead of using a general anaesthetic or arm tourniquet, the area is numbed precisely with local anaesthetic and adrenaline. This allows surgery to be performed comfortably, safely, and fully awake - with minimal downtime.
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The key advantage is real-time functional assessment during surgery. Whether repairing a tendon, releasing a nerve, or reconstructing a joint, patients can move their hands immediately, helping to ensure accurate tension, balance, and glide.​
Planning & Technique
WALANT can be applied to a wide range of hand conditions, including:
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Tendon release (e.g. trigger finger, de Quervain's)
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Tendon repair and tenolysis (release of adhesions)
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Nerve decompression and grafting (e.g. carpal tunnel, cubital tunnel)
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Scar and joint contracture release (arthrolysis)
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Local flap reconstruction (see my hand drawing below)
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Joint denervation or replacement (arthroplasty) of the hand
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Dupuytren’s disease (needle fasciotomy, surgical fasciectomy)
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Trauma (e.g. repair of fractures, nerves)
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Tendon transfers
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Excision of lumps (e.g. mucous cysts, ganglions)
The anaesthetic solution combines lidocaine and adrenaline, which provides both numbness and bloodless field visibility without the need for a arm tourniquet. The anaesthesia lasts several hours, so patients typically go home without much pain at all.
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I use fine-gauge infiltration techniques, pre-warming of the anaesthetic, and add a tiny bit of sodium bicarbonate to improve patient comfort during injection - small but significant details that greatly improves the treatment experience.
Recovery & Expectations
Because WALANT avoids general anaesthesia, patients recover almost immediately after the procedure. They can eat, walk, and use their hand lightly the same day. Early movement is encouraged under guidance to reduce stiffness and promote smooth tendon glide.
Most patients return to light daily activity within a few days, and depending on the procedure, structured hand therapy begins shortly after.
Follow-up reviews focus on function and scar care - helping patients return to work and activity as efficiently as possible.
Post-operative care extends beyond routine reviews - it is an integral part of Dr Ng’s surgical philosophy. Through Doctor Stitch, an aftercare service founded to ensure seamless continuity and comfort, every patient is followed up personally by Dr Ng. Whether at home or in clinic, he provides attentive, discreet, and consistent care throughout the recovery journey.
Related Reading​
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Joint fusion in hand arthritis (Journal of Hand Surgery American, 2025)
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Hand surgery under local anaesthetic (Journal of Hand Surgery Asian Pacific, 2024)
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Approach to hand trauma (Seminars in Plastic Surgery, 2015)
