The WALANT Approach: Advanced Surgical Precision
Experience a highly reliable, pain-free approach to hand surgery at our specialized practice. This method is meticulously designed to maximize your safety and ensure consistent outcomes without the need for general anesthesia.
Wide-awake hand surgery performed strictly under local anesthesia and without a tourniquet.
I am Dr. Alfonso Galán Jáuregui, an Orthopedic Surgeon specializing in Hand, Wrist, and Microsurgery. I have integrated the WALANT approach as a core component of my practice since 2022, currently performing between 20 and 30 procedures per month utilizing this highly reliable technique.
This method streamlines the surgical process without ever compromising exactness. It allows us to resolve numerous hand conditions without the risks of general anesthesia, the inconvenience of prolonged fasting, or the discomfort associated with a traditional tourniquet.
Furthermore, you remain fully awake and informed. In specific procedures, I will ask you to actively move your hand during the operation. The ability to instantly and objectively verify that a finger moves, a tendon functions flawlessly, or a blockage is entirely cleared guarantees consistent results and is one of the most powerful advantages of this technique.
To ensure maximum safety and eliminate unnecessary risks, all procedures are strictly performed in a fully equipped operating room. I do not perform these surgeries in an office setting; my protocol combines the advanced benefits of WALANT with the uncompromising safety, quality, and resources of a premier hospital environment.
What is WALANT Surgery?
WALANT stands for Wide Awake Local Anesthesia No Tourniquet.
In conventional hand surgery, it is standard practice to utilize general anesthesia, heavy sedation, regional arm blocks, or a painful tourniquet that intensely compresses the limb to control bleeding.
With the WALANT approach, I administer a precise anesthetic solution directly and exclusively to the targeted surgical site. This formulation contains a local anesthetic combined with a medication that temporarily constricts the microscopic blood vessels. This highly reliable method produces two critical effects:
Targeted Numbness: The specific surgical area remains completely anesthetized throughout the entire procedure.
No Tourniquet Required: Bleeding is effectively minimized without the need to painfully compress your entire arm.
The Patient Experience During the procedure, you remain fully awake and breathing comfortably on your own. You can speak with me, listen to music, ask questions, or simply relax while we perform the surgery.
Although you are completely conscious, your hand is thoroughly anesthetized. You may perceive movement or pressure as I work on the extremity, but the primary objective is to guarantee a pain-free operation without assuming the unnecessary risks and side effects associated with traditional anesthesia.
Why I Choose the WALANT Approach
1. Eliminates the Tourniquet
The tourniquet works by compressing the arm with high pressure. While useful in many conventional surgeries, it can cause an intense sensation of pressure or pain as minutes pass.
With WALANT, I can secure a clear, adequate surgical field without utilizing a tourniquet in the vast majority of procedures performed with this technique.
For many patients, avoiding the tourniquet represents a significant improvement in overall comfort.
2. Real-Time Result Verification
In specific operations, I do not have to wait for the patient to wake up from anesthesia to know how the hand functions.
I can ask you to bend or extend a finger, close your hand, or perform a specific movement. This allows me to directly observe if:
A trigger finger has stopped catching.
A repaired tendon glides correctly.
The tension of a repair is adequate.
There are any remaining points of blockage.
The desired range of motion is achieved.
This real-time verification allows me to make precise adjustments before completing the surgery, ensuring highly reliable and consistent outcomes.
3. The Patient Understands the Process
WALANT turns the patient into an active participant in their treatment.
During the procedure, I can explain exactly which structure is affected, what is being repaired, and the specific aftercare required. Many patients even decide to observe the results and move their hand with me.
Watching the surgery is never mandatory. Anyone who prefers not to look can utilize a visual screen, listen to music, or simply remain relaxed.
4. Eliminates Unnecessary Steps
When a procedure is performed exclusively under the WALANT protocol without sedation, it generally eliminates the need for:
General anesthesia.
Prolonged fasting.
Routine suspension of daily medications.
Preoperative laboratory tests for every patient.
Hospital overnight stays.
A prolonged post-anesthesia recovery period.
The necessity of additional tests, medications, or evaluations always depends on the exact diagnosis and each patient's specific medical history.
5. Faster Problem Resolution
Several common conditions can be definitively diagnosed during the initial consultation through a meticulous physical examination and an on-site diagnostic ultrasound.
When the diagnosis is clear, the patient is a candidate, and operating room availability aligns, I can offer a complete evaluation, surgical estimate, and perform the surgery on the very same day.
This efficient approach prevents you from enduring weeks or months of discomfort for a problem that already has a precise, defined solution.
6. A More Human Surgical Experience
One of the aspects I value most about WALANT is the ability to accompany the patient throughout the entire procedure.
You do not enter the operating room to lose consciousness and wake up disoriented, unaware of what happened. You can ask questions, understand the process, and personally observe how we restore a previously limited function.
After completing a trigger finger release, for example, the patient can immediately move their finger and objectively verify that the locking is entirely gone. That immediate reaction of relief and certainty is one of the primary reasons this technique has become such an essential element of my medical practice.
WALANT is Not an Office-Based Procedure
While performing WALANT procedures in an office setting is a common practice in certain countries—and many surgeons are perfectly comfortable doing so—that is simply not my preferred approach. Although this technique successfully eliminates the need for general anesthesia and a tourniquet, it remains a precise surgical intervention.
To guarantee absolute safety, eliminate unnecessary variables, and ensure highly reliable outcomes, I perform all procedures strictly within a fully equipped hospital operating room.
My objective is to seamlessly combine the best of both models:
The streamlined comfort and simplicity of local anesthesia.
The active participation of the patient to verify results in real time.
True outpatient efficiency, allowing you to safely return to your home or hotel the exact same day.
The uncompromising safety, infrastructure, and emergency protocols of a premier hospital environment.
The rigorous sterility standards, specialized surgical staff, and advanced equipment required for a flawless procedure.
Procedures Performed with WALANT
I utilize the WALANT approach to effectively treat a variety of hand conditions and injuries.
The three most frequent procedures I perform using this highly reliable technique are:
De Quervain's Tenosynovitis Release
De Quervain's tenosynovitis causes significant pain on the thumb side of the wrist.
It commonly hurts when lifting objects, opening jars, using a smartphone, lifting a baby, or performing repetitive thumb movements.
During surgery, I meticulously release the affected tendons, allowing them to glide freely and smoothly once again without pain.
Trigger Finger Release
Trigger finger occurs when a tendon cannot glide correctly, causing the finger to catch, pop, or become locked in a bent position.
During surgery, I precisely release the structure impeding its movement.
A major advantage of WALANT is that I can ask you to actively bend and straighten your finger during the procedure. This allows us to instantly and objectively verify that the locking has been completely resolved.
Carpal Tunnel Release
Carpal tunnel syndrome is caused by the compression of the median nerve in the wrist.
During the procedure, I release the nerve to effectively decrease the pressure within the carpal tunnel.
In carefully selected patients, this surgery can be performed utilizing the WALANT approach—safely avoiding general anesthesia and eliminating the use of a tourniquet.
Additional Procedures Performed with WALANT
Depending on the precise diagnosis and the complexity of the injury, I also utilize the WALANT approach for:
Excision of tumors, cysts, and soft tissue masses.
Flexor tendon repair.
Extensor tendon repair.
Traumatic hand injuries.
Metacarpal fractures.
Phalangeal (finger) fractures.
Fingertip injuries.
Selected nerve repairs.
Complex hand reconstruction.
Urgent trauma and wound surgery.
Please note: Not all fractures, injuries, or hand reconstructions can be treated with the exact same approach.
The surgical indication depends entirely on the precise location of the injury, the time since onset, potential damage to surrounding structures, and each patient's specific medical conditions. Every case is meticulously evaluated to ensure the safest and most reliable treatment plan.
Schedule an Evaluation
During the consultation, I will determine:
Your precise diagnosis.
Whether surgery is necessary.
If the WALANT approach is appropriate for your specific case.
The exact procedure I recommend.
If any additional diagnostic studies are required.
The expected recovery timeline.
The possibility of performing the procedure on the very same day.
A complete, transparent cost estimate.
Important Medical Information
This website is for educational and informational purposes only.
It does not substitute a professional in-person medical evaluation.
The recommendation for surgery, anesthesia, diagnostic studies, medications, and postoperative care depends entirely on each patient's individual characteristics.
Results may vary, and no surgical procedure is entirely free of risks.