Wide awake local anaesthesia no tourniquet surgery of the foot and ankle: a review of indications, technique, patient satisfaction, and complications

Abstract

Wide-awake surgery of the hand was surrounded by a lot of apprehension, mainly over concerns around using epinephrine near digits and its potential to cause digital ischemia and necrosis. With multiple reports underlining its safety and effectiveness, it is now being widely adopted in hand and wrist surgery. The British Society for Surgery of the Hand has already published guidelines on operating outside of main theatres, with an emphasis on wide awake local anaesthesia no tourniquet (WALANT). However, the same cannot be said for its use in foot and ankle procedures. There have been a handful of reports describing WALANT in bony and soft tissue procedures of the foot and ankle, with varied success. We aim to describe the scope of WALANT in these procedures and explore in detail its current role in the domain of lower extremity wide-awake surgery.