NW Orthopaedic Specialists WALANT Hand Surgery

WALANT Hand & Wrist Surgery

WALANT (Wide Awake Local Anesthesia No Tourniquet) Surgery

Overview of WALANT technique

Wide Awake Local Anesthesia No Tourniquet (WALANT) is a technique for hand and wrist surgery without sedation or general anesthesia. Throughout the procedure, patients are awake, no tourniquet is used, and only local anesthesia is used. This technique offers many advantages over standard procedures including being less expensive and a healthier alternative to sedation or general anesthesia. 

Surgeries that can be performed using WALANT

  • Carpal tunnel release
  • Trigger finger release
  • DeQuervain’s release
  • Mucous cyst excision
  • Wrist ganglion excision
  • Fingertip reconstruction
  • Cubital tunnel release
  • Finger and hand mass excision
  • Finger fracture repair
  • Extensor tendon repair
  • Flexor tendon repair
  • Finger and thumb arthritis surgeries
  • Tendon transfers

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Advantages of using WALANT

  • Patients are awake during the procedure, which allows for better communication with the patient. Because there is no sedation, it’s easier for patients to remember what their surgeon tells them about the surgery.
  • No need for a tourniquet.
  • Patients do not need to fast before surgery.
  • Patients do not need to stop any of their daily medications.
  • There is no need for preoperative testing, placement of an IV, or discomfort during or after the surgery.
  • Less time at the surgery center for the procedure as there is little to no recovery time from the surgical procedure.
  • Lower costs than traditional surgery.
  • Healthier and safer alternative to sedation or general anesthesia.

Overall, WALANT provides a less expensive and easier surgical experience, making it an effective choice for many NWOS patients.

WALANT with Northwest Orthopaedic Specialists

NWOS Hand Surgeon Dr. Anthony Sestero is the first surgeon in the region performing WALANT Hand & Wrist Surgery, and these procedures will be the type of surgery performed at the brand new NWOS Orthopaedic Surgery Center in Spokane Valley, which will be opening in 2024. When open, the new Ambulatory Surgery Center will be the only one of its kind in the region.

NWOS Spokane Valley

NWOS Spokane Valley


Dr. Sestero shares his perspective on the value WALANT hand surgery provides:

Dr. Anthony Sestero Orthopedic Hand and WALANT Surgeon at NWOS“There are numerous benefits to performing hand surgery with only local anesthetic. The technique used to perform surgeries with only local anesthesia is termed WALANT. This is an acronym for Wide-Awake Local Anesthesia No Tourniquet. Traditionally the majority of hand surgery was performed under general anesthesia or with the use of local anesthesia while under sedation. One of the main benefits of WALANT is the avoidance of any form of sedation or anesthesia that would effect the patient's consciousness, memory, or have systemic health effects. It is therefore, I believe, a healthier way in which to have hand surgery performed. By eliminating the need for general anesthesia or sedation, the patient is no longer required to avoid eating or drinking for several hours prior to the procedure, adjust their typical medications, undergo preoperative evaluations such as an EKG or blood tests, or have an IV placed on the day of the surgery. There are numerous benefits to WALANT surgery while the patient is in the operating room also. The patient and surgeon are able to have a discussion about the procedure and the best ways in which to maximize recovery in the immediate postoperative period. The discussions during surgery often lead to insights about the patient and the procedure that can improve the surgeries outcome. Additionally, although the patient will have no painful sensations during the procedure, they are able to move the wrist and digits at the surgeon's request which is useful to confirm that the surgical repair has been successful. This is used most notably during trigger finger release, tendon repair repair, and tendon transfer surgery. Postoperatively, the patient no longer needs to recover from sedation or the possible complications of that sedation, such as nausea. They feel alert and are able to be discharged from the surgical facility almost immediately. The financial benefits of the surgery to the patient include decreased cost with the avoidance of sedation or general anesthesia and a shorter period of time in the operating room. Many of these procedures can be performed utilizing fewer disposable products that can lead to greatly decreased waste and a smaller impact on the environment. I have been performing hand surgery for over 18 years and definitely feel as though WALANT is one of the greatest improvements in our field of surgery during that time. If I were to have hand surgery I would prefer to have it performed under this technique. I am extremely excited to offer this technique to my patients and now use it for the majority of surgeries that I perform.”


Contact your NWOS hand and wrist surgeon to find out if your surgery can be done with WALANT.