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Wide-Awake Local Anesthesia No-Tourniquet (WALANT) versus Traditional Anesthesia for Common Hand Procedures: A Multi-institutional, Propensity-Matched Cohort Analysis
Samantha Cervantes Valadez, M.D.
1, Yousef Tanas, M.D.
1, Lauren Abigail Hoffpauir, BS BA.
1; Anthony Echo, M.D.
2(1)Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, (2)Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, TX
Introduction: The use of Wide-Awake Local Anesthesia No Tourniquet (WALANT) has grown substantially for common hand surgeries, including carpal tunnel release, trigger finger release, and Dupuytren's contracture procedures. Despite increasing adoption, comparative evidence from large-scale studies remains scarce. This study evaluates perioperative complications, healthcare resource utilization, and opioid consumption following WALANT compared to traditional anesthesia approaches.
Methods: A retrospective cohort analysis was performed utilizing data from the TriNetX Global Collaborative Network, encompassing 146 healthcare institutions. Patients who underwent carpal tunnel release, trigger finger release, or Dupuytren's contracture surgery between 2005 and 2025 were categorized into two groups: WALANT (n = 32,415) and traditional anesthesia (regional anesthesia with or without tourniquet, or general anesthesia, n = 4,627). Propensity-score matching (1:1 greedy nearest-neighbor) controlled for age, sex, race/ethnicity, BMI, diabetes mellitus, cardiovascular disease, and nicotine use, resulting in matched cohorts of 4,425 patients each. Outcomes were assessed within 180 days postoperatively, with calculation of relative risks (RR) and 95% confidence intervals (CI).
Results: Following matching, WALANT was associated with significantly reduced rates of hematoma formation (0.9% vs 1.6%; RR 0.55, Cl 0.37-0.81; p= 0.002), nerve injury diagnoses (35.9% vs 45.6%; RR 0.79, CI 0.75-0.083; P < 0.001), emergency department visits within 6 months (5.5% VS 7.0%; RR 0.78, CI 0.66-0.92; p = 0.002), and opioid prescriptions (22.6% VS 32.4%; RR 0.70, CI 0.65-0.75; p < 0.001). Although not statistically significant, trends favoring WALANT were observed for surgical-site infections (0.3% vs. 0.6%; p= 0.078), reoperation rates (0.2% vs. 0.4%; p= 0.143), and occupational therapy utilization (8.2% vs 9.3%; p= 0.091).
Conclusion: This large-scale, multi-institutional propensity-matched analysis shows that WALANT significantly decreases hematoma incidence, nerve-related complications, emergency department visits, and postoperative opioid exposure compared to traditional anesthesia methods. These outcomes support WALANT as a safe, effective, and resource-efficient anesthesia approach for common hand procedures. Future prospective studies evaluating cost-effectiveness and short-term quality of care outcomes are warranted to further establish WALANT's role in clinical practice.
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