Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus General Anesthesia for Pediatric Trigger Thumb Release: Clinical Outcomes, Efficiency, and Costs.

PURPOSE: The wide-awake local anesthesia no tourniquet (WALANT) approach has been proposed as a promising alternative to general anesthesia (GA) for hand surgery. However, evidence in the pediatric population remains limited. The objective of this study was to evaluate its impact on clinical outcomes, procedural efficiency, and institutional costs for pediatric trigger thumb (PTT) release.

METHODS

A retrospective cohort study was conducted on all patients (≤18 years) who underwent open PTT release by a single surgeon at a tertiary pediatric hospital between August 2020 and May 2025. Patients were grouped by approach: WALANT, executed in a minor procedure room, or GA, executed in a traditional operating room. Patient demographics, clinical findings, surgical details, and postoperative outcomes were extracted and compared. An efficiency analysis was performed to assess time parameters, and a cost analysis was performed to assess financial implications.

RESULTS

Fifty-six patients were included; 39 underwent WALANT, and 17 received GA. Patients receiving WALANT were significantly older (6.5 vs 3.6 years). Both groups achieved comparable clinical outcomes, with 91% of WALANT and 90% of GA cases demonstrating complete symptom resolution. No complications were reported, and no cases performed using WALANT required conversion to GA. WALANT procedures had significantly shorter minor procedure room/operating room duration (22 vs 36 minutes) and hospital stay (52 vs 442 minutes). The total cost was considerably lower for WALANT, resulting in savings of $7,006.59 Canadian dollars per case.

CONCLUSIONS

WALANT is a safe and effective alternative to GA for PTT release. It offers equivalent clinical outcomes while considerably improving procedural efficiency and reducing institutional costs. These findings strongly support the wider adoption of WALANT in pediatric hand surgery, aligning with goals to optimize resource use without compromising patient care.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic 2b.