Wide-Awake Local Anesthesia No Tourniquet: From Elective Hand Surgery to Fracture Fixation. A Systematic Review, Meta-Analysis, and Narrative Synthesis
In brief
WALANT procedures were about 11 minutes shorter, with comparable outcomes in selected fractures
Across 16 comparative studies, wide-awake local anesthesia without a tourniquet was associated with procedures about 11 minutes shorter, while functional outcomes were comparable across elective hand surgery and selected upper-extremity fracture fixation. The review found no significant differences in complications or revision procedures, but the fracture findings apply only to selected cases and need confirmation in broader evidence.
- Journal
- Orthopedic reviews (Q2)
- Published
- 19 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Inger Lund-Kordahl, Kari Lund-Kordahl
- PMID
- 42908549
- DOI
- 10.52965/001c.172372
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (top studies of the week, 25 October 2026): Comparative evidence for wide-awake hand surgery
Abstract
BACKGROUND: WALANT is well established in elective hand surgery, where it has demonstrated favorable clinical outcomes and improved perioperative efficiency. More recently, its use has expanded to selected upper-extremity fracture procedures, but whether the benefits are maintained remains uncertain. This systematic review combined meta-analysis and narrative synthesis to evaluate the clinical outcomes, safety, patient-reported outcomes, and perioperative efficiency of WALANT across elective hand surgery and fracture fixation. OBJECTIVE: To evaluate the contemporary evidence for WALANT across elective and acute upper-extremity surgery and determine whether the established benefits of elective surgery are preserved in selected fracture procedures. METHODS: A systematic review and meta-analysis was conducted according to PRISMA 2020. PubMed, Embase, and the Cochrane Library were searched for comparative studies published between January 2018 and November 2025. Risk of bias was assessed using RoB2 and ROBINS-I. Random-effects meta-analysis and structured narrative synthesis were performed. RESULTS: Sixteen studies met the inclusion criteria. Meta-analysis showed no significant differences in complications (RR 0.37, 95% CI 0.12-1.16) or revision procedures (RR 0.88, 95% CI 0.19-4.15). Functional outcomes were comparable across elective and acute procedures. WALANT consistently improved perioperative efficiency (MD -11.2 minutes, 95% CI -15.4 to -6.9), and subgroup analyses demonstrated that the favorable findings established in elective surgery were largely maintained in selected fracture fixation procedures. CONCLUSIONS: The favorable outcomes established for WALANT in elective hand surgery appear to be maintained in selected acute upper-extremity fracture procedures, supporting its role as a safe and resource-efficient option across selected upper-extremity surgery.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.