Welcome!
Wide Awake Hand Surgery
WALANT (Wide Awake Local Anaesthesia No Tourniquet) hand surgery uses targeted local anaesthesia without sedation or a tourniquet to allow cooperative patient assessment, refined intra-operative judgement and enhanced safety in selected hand procedures.
​
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.
​
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.​
​
Indeed, studies have shown the WALANT approach to hand surgery to be non-inferior to traditional surgery done under general anaesthesia or regional blocks. In fact, experts all over the world have largely been converted to WALANT, due in large part to COVID during which operating theatre access became limited.
Planning & Technique
WALANT can be applied to a wide range of hand conditions, including:
-
Tendon release (e.g. trigger finger, de Quervain's)
-
Tendon repair and tenolysis (release of adhesions)
-
Nerve decompression and grafting (e.g. carpal tunnel, cubital tunnel)
-
Scar and joint contracture release (arthrolysis)
-
Local flap reconstruction (see my hand drawing below)
-
Joint denervation or replacement (arthroplasty) of the hand
-
Dupuytren’s disease (needle fasciotomy, surgical fasciectomy)
-
Trauma (e.g. repair of fractures, nerves)
-
Tendon transfers
-
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.
​
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.
Frequently Asked Questions
1. What does “wide awake” mean in WALANT hand surgery?
“Wide awake” means the procedure is performed under local anaesthesia only, with no sedation or general anaesthesia, allowing real-time patient interaction and assessment without a tourniquet.
​
2. Which hand conditions can be treated with WALANT?
Many conditions benefit from WALANT, including trigger finger release, small soft-tissue tumours, carpal tunnel release, De Quervain’s tenosynovitis, and selective nerve or tendon procedures where cooperative testing improves outcomes.
3. Is WALANT surgery painful?
Local anaesthesia is delivered slowly with technique-specific buffering and infiltration to minimise discomfort. Once anaesthetised, patients typically feel no surgical pain and remain fully cooperative throughout. If necessary, intra-operative topping up of local anaesthesia can be done.
4. Are there any safety advantages to WALANT?
Yes, eliminating sedation and tourniquets reduces risks associated with general anaesthesia and muscle relaxants, enhances cardiovascular stability, and allows immediate functional assessment, in keeping with my practice focus.
​
5. Can WALANT be used for complex hand surgery?
WALANT is excellent for many soft-tissue and selected tendon/nerve procedures. Complex reconstructions requiring extensive release, microsurgery or bone work may still be better suited to traditional anaesthetic approaches although there are ever-expanding indications for WALANT.
6. How long is recovery after WALANT hand surgery?
Recovery timelines vary with the procedure, but many patients return to gentle use early, with formal rehabilitation and mobilisation guidance tailored to the specific operation. Otherwise, the WALANT wears off after 3-4 hours on average and standard pain medications will suffice.
​
Related Reading​
-
Joint fusion in hand arthritis (Journal of Hand Surgery American, 2025)
-
Hand surgery under local anaesthetic (Journal of Hand Surgery Asian Pacific, 2024)
-
Approach to hand trauma (Seminars in Plastic Surgery, 2015)
