Wide-Awake Local Anesthesia No Tourniquet in hand surgery: A systematic review and meta-analysis.

WALANT (Wide Awake Local Anesthesia No Tourniquet) has been widely implemented in hand surgery. We conducted a systematic review from 1979 to 2022, led by a team of anesthesiologist. Only randomized studies comparing WALANT to other types of regional anesthesia were included. The outcomes studied were pain, duration of the procedure, intraoperative bleeding, complications, and patient satisfaction. Twelve articles were included in the analysis. We found a reduction of 2.77 on the VAS (95% CI -3.79; -1.75, I² 93%) for intraoperative pain in the WALANT group. There was no significant difference (MD 0.79, 95% CI 95% -0.11; 1.69, I² 73%) for duration of surgery. Patient satisfaction was consistently high in the WALANT group. Intraoperative bleeding was minimal and not clinically relevant. Compared to other types of regional anesthesia in hand surgery, the WALANT technique decreases pain for the patients without increasing the length of surgery.