Hand surgery without the operating room.
Surgeons call it WALANT: Wide Awake, Local Anesthesia, No Tourniquet. Carpal tunnel, trigger finger and other common hand procedures, done in our Stone Oak office with numbing medicine only. Eat breakfast and keep taking your usual medicines.
You stay awake and comfortable. Your hand is numb.
Wide-awake hand surgery uses a local anesthetic with a small amount of epinephrine. The lidocaine numbs the area. The epinephrine keeps bleeding low, so there’s no need for a tight tourniquet on your arm.
About the name. WALANT is short for Wide Awake Local Anesthesia No Tourniquet. You’ll also see it called wide-awake hand surgery or awake hand surgery. They all mean the same thing: your hand is numbed, you stay awake, and no tourniquet is needed.
You won’t need an IV, a breathing tube, or medicine to put you to sleep. You can talk with Dr. Jackson during the procedure, and you pick what we play on the radio. A drape blocks your view unless you’d like to watch.
Because you’re awake, Dr. Jackson can ask you to move your finger or thumb during surgery. In trigger finger release, for example, you bend and straighten the finger on the table so he can confirm the catching is gone before closing.
What “WALANT” stands for
No sedation, no general anesthesia, no grogginess afterward.
Lidocaine with epinephrine, placed with a thin needle and given slowly.
Epinephrine controls bleeding, so there’s no painful arm cuff.
Wide-awake in our office vs. the traditional route
Both are safe, proven options, and many of the same procedures can be done either way. Here’s how the experience differs.
| Wide-awake, in our office | Hospital or surgery center | |
|---|---|---|
| Anesthesia | Local numbing medicine only | Sedation or general anesthesia, plus local |
| Eating beforehand | Eat and drink normally | Nothing to eat after midnight |
| Pre-op testing | Usually none needed | Often labs, EKG or medical clearance |
| IV and arm tourniquet | Neither | Both, in most cases |
| Your usual medicines | Keep taking them, including blood thinners (we’ll review your list) | Some may need to be stopped or adjusted |
| Getting home | You can drive yourself | A driver is required after sedation |
| Time on site | About 90 minutes to 2 hours | Often half a day |
| Bills | One bundled cash price, or one insurance claim | Separate surgeon, facility and anesthesia bills |
Who does well with wide-awake surgery
Often a great fit
- You’d rather avoid anesthesia, or you felt sick or foggy after it before
- You have heart, lung or sleep-apnea issues that make sedation riskier
- You’re older and want to skip pre-op testing and a long day at a facility
- You have no insurance and want one clear price
- You want to get back to one-handed work or errands the same day
We may suggest a surgery center instead
- You’re very anxious about being awake or about needles. We’ll talk it through, and sedation remains an option.
- The procedure is larger or longer, like fracture plating or joint reconstruction.
- You’ve had a rare reaction to local anesthetics.
- Your exam shows something that needs a different approach.
Not sure? The Symptom & Cost Guide can point you in the right direction, and we’ll confirm the right plan with you at your consultation.
Twenty years of evidence
Wide-awake hand surgery was popularized and studied by hand surgeons in Canada and is now used around the world. A few of the findings:
consecutive hand and finger cases using epinephrine with no loss of finger tissue. This study helped retire the old “no epinephrine in fingers” rule.
Lalonde et al., J Hand Surg Am, 2005superficial infection rate and no deep infections across 1,504 carpal tunnel releases done in minor procedure rooms.
Leblanc et al., Hand (N Y), 2011of patients who had wide-awake carpal tunnel release said they would choose it again.
Davison, Cobb & Lalonde, Hand (N Y), 2013wide-awake patients looked for opioid pain medicine after surgery. Pain scores two weeks out were lower than in patients who had sedation.
Dar et al., Plast Reconstr Surg, 2021What we treat wide-awake
Endoscopic Carpal Tunnel Release
Releases the ligament pressing on the median nerve through a wrist incision under ½ inch, using a small camera.
Carpal tunnel syndromeOpen Carpal Tunnel Release
Short palm incision to release the ligament pressing on the median nerve.
Trigger finger or thumbTrigger Finger Release
Releases the A1 pulley so the tendon glides without catching.
Thumb-side wrist painDe Quervain’s Release
Opens the tight tunnel around the thumb tendons at the wrist.
Bump near the fingernailMucous Cyst Excision
Removes the cyst and the bone spur underneath it.
Lump on the finger or palmFinger Mass Excision
Removes the lump; solid masses are sent for lab testing.
Dr. Russell Brent Jackson
Dr. Jackson is a board-certified orthopedic surgeon who completed his hand and upper extremity fellowship at the Hand Center of San Antonio. He has cared for San Antonio patients in his own practice since 2014.
Because we’re a solo practice, you’ll talk to a real person when you call. Your consultation may be with Dr. Jackson or with his PA or NP. Either way, Dr. Jackson personally performs every surgery. He has performed hundreds of procedures in the office under local anesthesia.
Wide-awake surgery FAQ
Have a question that isn’t here? Call us at (210) 729-1900 and you’ll reach our team directly.
Does it hurt?
The numbing injection is the only part most people feel. Dr. Jackson uses a thin needle and injects slowly, which makes it much more comfortable. After that you’ll feel pressure and movement but not sharp pain.
Can I eat and take my medicines?
Yes. Eat a normal breakfast and take your usual medicines, including blood thinners. Bring your medication list to your consultation so we can review it with you.
Will I see the surgery?
Only if you want to. A drape blocks your view. Most people chat, listen to the radio, or close their eyes.
Can I drive myself home?
Yes. There’s no sedation, so you can drive yourself. Bring a driver only if you’d prefer not to drive.
Is it safe to operate without a tourniquet?
Yes. Epinephrine narrows small blood vessels, keeping the surgical field clear. Large studies have shown it’s safe in the hand and fingers.
Can both hands be done on the same day?
We usually do one hand at a time. That leaves your other hand free for heavier lifting while the first one heals. The other side can be done within a couple of weeks.
Does insurance cover wide-awake surgery?
Yes. We bill most major insurance plans for in-office surgery, including Blue Cross Blue Shield, Medicare, United, Aetna and Oscar. Some insurance plans don’t cover procedure supplies, so there may be an additional cost. Supplies range from $100 to $250. If you don’t have insurance, see our cash prices.
What if I get nervous during the procedure?
Tell us. We’ll pause, talk you through it, and adjust. If you know ahead of time that being awake isn’t for you, we can schedule the same procedure at a surgery center with sedation.
Find out if wide-awake surgery is right for you.
Call (210) 729-1900 or book online. You’ll always reach a real person.