Abstract
Objectives: Recently, many surgeons started to prefer wide awake local anesthesia no tourniquet (WALANT) approach to provide an almost bloodless field for the vast majority of hand surgery procedures. We aimed to present our two-year experience with WALANT technique.
Methods: A wide variety of 682 hand surgery operations in 626 patients were performed with WALANT technique. For infiltrative local anesthesia, the mixture of 1% lidocaine, 1:100.000 epinephrine and 8.4% bicarbonate was prepared. The need for intraoperative sedation and intraoperative patient cooperation were evaluated. Patients' fingers were observed in case of postoperative circulatory compromise. A simple cost-effectivity analysis for the anesthesia types was performed.
Results: Mean age of the patients was 43.7. None of the patients needed intraoperative sedation, and patients obeyed to orders of surgeon throughout the procedure. The postoperative circulatory compromise was observed in two fingers; one finger resolved spontaneously and the other rescued with phentolamine. WALANT technique was more cost-effective than Bier block or general anesthesia.
Conclusion: The WALANT technique seems like a great innovation to perform a wide variety of hand surgery cases. Increased patient comfort without a tourniquet, cost-effectivity, no preoperative tests, no risks of general anesthesia, no need to stay in the hospital overnight, and intraoperative active motion assessment facility are important advantages.

Key words: Wide awake hand surgery, WALANT, tourniquet, epinephrine