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Wide Awake Local Anesthesia No Tourniquet (WALANT) for Pediatric Hand Surgery: A Systematic Review
Aidan Shulkin, MD, Daniel E. Borsuk, OQ, MD, MBA, FRCSC, FACS; Emilie Bougie, MD, MHPE, FRCSC
Centre hospitalier universitaire Sainte-Justine, Montreal, QC, Canada
Introduction:Wide Awake Local Anesthesia No Tourniquet (WALANT) has gained increasing popularity in adult hand surgery due to its faster recovery, reduced costs and resource use, and higher patient satisfaction when compared to traditional systemic anesthesia. However, its application in pediatrics remains limited. This systematic review aims to evaluate the current evidence on WALANT for pediatric hand surgery to guide future directives.
Materials & Methods: Embase, MEDLINE, CENTRAL and Web of Science were searched to identify studies that employed WALANT for hand surgery in the pediatric population (?18 years old). Studies published from inception to June 2025 were included. For those meeting inclusion criteria, study and patient characteristics, interventions, and outcomes were extracted and analyzed. A risk of bias assessment was conducted.
Results: Ten studies were included, representing 411 subjects and 477 procedures. The mean age of subjects was 8.7 years. 341 (71.5%) tendon-based procedures were performed, including trigger finger release, tenorrhaphy, tenolysis, tendon transfer, and pulley reconstruction. 64 (13.4%) excision-based procedures were performed, including cysts, tumours and foreign bodies. 32 (6.7%) bone-based procedures were performed, including open reduction/internal fixation, hardware removal, and closed reduction/percutaneous pinning. 40 (8.4%) other procedures were performed, including scar revision, cubital tunnel release, digital nerve/artery repair, and irrigation/debridement.
No complications were reported. Only one case required conversion of local anesthesia to general anesthesia. One study utilized a custom questionnaire to assess patient perspectives. The vast majority of patients reported no pain during the administration of local anesthesia or the procedure itself, found the experience easier than anticipated, and expressed a preference for WALANT in future surgeries. Compared to systemic anesthesia, two studies reported significant reductions in total procedure time and hospital stay. Additionally, one study demonstrated notable decreases in postoperative narcotic use, pain scores, and cost. Overall, the procedures were successful and well-tolerated.
Conclusion:Current literature on the use of WALANT in pediatric hand surgery is limited but shows promising results. With appropriate patient selection, WALANT appears to be a safe and feasible alternative to systemic anesthesia for a variety of procedures. More research is needed to comprehensively evaluate clinical outcomes, complication rates, patient satisfaction, and the potential cost and environmental benefits. Expanding this evidence base may ultimately enhance patient experience, optimize surgical planning, and improve resource utilization in pediatric hand surgery.
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