OrthoNebraska offers more convenient approach to hand, wrist surgery

WALANT is an innovative approach to hand and wrist surgery that is rapidly gaining in popularity because it reduces the risk of complications and is more convenient for patients.

When Janet Klostermann heard she was going to be awake for her hand surgery this past November, she was a bit surprised, but really appreciated the ability to have the procedure she needed done quickly.

"It was really easy and fast to schedule," Klostermann said. "I didn't need anyone to come with me and the whole process was really simple."

WALANT is an innovative approach to hand and wrist surgery that is rapidly gaining in popularity because it reduces the risk of complications and is more convenient for patients. The acronym stands for Wide Awake Local Anesthesia No Tourniquet. Because only local anesthetic is used rather than putting the patient to sleep, most of the protocols associated with traditional surgery are avoided.

"Patients can eat whenever they’d like, drive themselves to and from the procedure, don't need to wear a gown and can stay on all daily medications," said orthopedic hand surgeon Dr. Alex Lesiak, one of several at OrthoNebraska offering the WALANT approach. "It's just a lot less of a hassle."

All this adds up to a surgery that can be handled alone over a long lunch rather than taking an entire day and requiring support from family or friends. WALANT procedures are performed in new treatment rooms at OrthoNebraska Hospital, so the same orthopedic support staff with orthopedic expertise are on hand to ensure everything runs smoothly.

Dr. Alex Lesiak

"I didn't have any issues with being awake," Klostermann continued. "The staff let me know what was going on throughout and I never felt uncomfortable."

Rather than being put to sleep and wheeled in, patients simply walk into the room and sit or lie down. Then, the surgeon proceeds with local anesthesia followed by sterilization. A drape with a hole goes over the patient's arm, they get headphones and music or TV going, and then the actual procedure begins.

"Typically, we administer fast-acting lidocaine with epinephrine for anesthesia and pain relief," said Dr. Lesiak. "Other than one small poke at the beginning, patients don't feel anything."

Another benefit of WALANT is that patients can still move their hand and wrist if desired. For many types of procedures, most notably trigger finger corrections, the surgeon can work with the patient to test the outcome of surgery immediately.

Because only local anesthetic is used rather than putting the patient to sleep, most of the protocols associated with traditional surgery are avoided.

"When I’m finished with the surgery, the patient can move their finger and I can ensure it no longer clicks, catches or locks like it did before," Dr. Lesiak said. "I can even make adjustments if necessary. While rare under previous methods, this almost eliminates the potential for having to have the patient come back for another corrective surgery."

Klostermann also appreciated the unique aspect of being able to be fully aware and talk to her surgeon during surgery.

"They asked what kind of music I wanted to listen to, and I said the Beatles," Klostermann said. "It turned out Dr. Lesiak is also a fan and we talked about how we were both going to the upcoming interactive show that came to town."

While the chatter may have made it feel faster, she was impressed at the efficiency of the whole process.

"Dr. Lesiak told me it was over before it was scheduled to even start!" Klostermann said.

You can learn more about WALANT or make an appointment by visiting OrthoNebraska.com/WALANT, calling 402-609-3000 or texting 844-399-8240.

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