AB130. SOH26AB_0257. Complication rates in hand surgery: a systematic review and meta-analysis of wide-awake local anaesthesia no tourniquet vs. other anaesthetic techniques

Background: Wide-awake local anaesthesia no tourniquet (WALANT) has emerged as an alternative to conventional anaesthetic modalities in hand surgery. Through the combined use of lidocaine and epinephrine, WALANT provides effective analgesia and haemostasis without sedation or tourniquet application, enabling intraoperative functional assessment. Although increasingly adopted, anaesthetic practice remains heterogeneous, and uncertainties persist regarding the comparative safety of WALANT. This review aims to synthesise evidence on complication rates and secondary outcomes to clarify its role within contemporary practice.

Methods: This PROSPERO-registered systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches of PubMed, Embase, Scopus, and Cochrane databases identified randomized controlled trials comparing WALANT with general, regional, or local anaesthesia in adult hand surgery. Eligible English-language studies reported complication rates, with secondary outcomes including procedure type, anaesthetic formulation, intra- and postoperative pain, and patient satisfaction. A random-effects meta-analysis was performed to account for methodological and clinical heterogeneity.

Results: Six randomized controlled trials encompassing 433 patients met the inclusion criteria. Pooled analysis demonstrated no statistically significant difference in overall complication rates between WALANT and comparator anaesthetic techniques [relative risk (RR) =0.72; 95% confidence interval (CI): 0.31–1.67; P=0.45; I²=17%]. Complications were infrequent across all groups, with no reports of digital ischaemia. Pain outcomes were comparable or lower with WALANT, and patient satisfaction was consistently high.

Conclusions: WALANT appears to be a safe, well-tolerated anaesthetic strategy for hand surgery, exhibiting low complication rates and favourable patient-reported outcomes. Further high-quality, adequately powered trials are warranted to consolidate current evidence and delineate its optimal application across surgical contexts.

Keywords: Adrenaline; anaesthesia; complications; hand surgery; wide-awake local anaesthesia no tourniquet (WALANT)