Wide Awake Hand Surgery May Sound Scary, but Has Many Benefits

7/16/2026

By Kathleen Robertson, M.D.
MountainView Medical Group

The world is changing fast! Changing along with it are advances in hand surgery. One such advancement is WALANT (wide awake local anesthesia no tourniquet) surgery -- a very safe technique for certain types of procedures.

Being awake during a surgery may sound scary, but for some, it can be less fearful than the potential effects of general anesthesia. For instance, general anesthesia can involve addictive medications such as opioids and inhalational gas. Older patients sometimes avoid surgery altogether due to concerns about cognitive decline and other complications that can occur with general anesthesia. Particularly for those who live alone, wide awake surgery can help them maintain their independence through both mental clarity and physical stability when discharged after the procedure.

How it works

In the pre-op area, the surgeon will inject a numbing solution to completely desensitize the area around the surgical site. The solution contains an anesthetic (like lidocaine), and often bicarbonate to reduce any stinging sensations and epinephrine to constrict blood vessels (for the “no tourniquet” part of WALANT). After the local anesthetic has taken effect, the surgery is completed in an operating room just as it would be done under general anesthesia and using the same surgical instruments.

The wide awake technique can be used for a wide range of procedures: carpal tunnel, trigger finger and De Quervain's release; excisional biopsy of a mass/tumor; mucoid cyst excision; finger joint replacement or fusion; fracture fixation; and nerve and tendon repair.-

Advantages of wide awake surgery

For some people, the ability to observe their own hand or wrist procedure – including movement of their tendons, what nerves look like, active finger motion after a joint replacement, and joining in the conversation – is enough. But there are clinical advantages, too.

• Typically, local anesthesia has no side effects.
• Patients experience no sedation or sleepiness, no nausea, and no restrictions on eating or light activities.
• Out-of-pocket costs will not include charges for an anesthesia healthcare provider.
• The WALANT technique can also greatly reduce the time from arrival to discharge from the hospital by several hours when compared to the same procedure under general anesthesia.
• Interaction between the surgeon and the patient is ongoing, so postoperative care and instruction for home exercise are reviewed at length. (Most patients do not need formal hand therapy.)

The patient experience for WALANT generally is all smiles – thanks to no pain and decreased anxiety. For the surgeon, WALANT allows them to assess their work as the patient participates through active motion, hence testing the repair of fracture, nerve, or tendon repair.

Kathleen Robertson, M.D., is a board-certified, fellowship-trained orthopedic surgeon specializing in hand, wrist and upper-extremity surgery at MountainView Medical Group – Orthopedics and Musculoskeletal Care. To schedule an appointment call (575) 532-9755. Dr. Robertson is employed by Las Cruces Physician Services, LLC, d/b/a MountainView Medical Group.

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