WALANT Hand Surgery: Do the AORN Guidelines Apply?


This study evaluates current guidelines for patients receiving local anesthesia, set forth by the Association of Perioperative Nurses (AORN), within the context of hand surgery. The study reviewed 217 patients and 265 operations performed under wide-awake local anesthesia no tourniquet (WALANT) technique in an outpatient procedure room with minor field sterility. Only the surgeon, one resident, and one circulating nurse were present. All surgical complications were documented, including any infection at postoperative follow-ups. One female patient developed a deep surgical site infection (SSI) following repair of her flexor digitorum superficialis and flexor digitorum profundus, which resolved after irrigation/debridement. We report 0% intraprocedural complication, 0% superficial SSI, and 0.37% deep SSI (n = 1) incidence across this cohort. Most institutions require two nurses present for local anesthesia, but our low complication and infection incidence suggest a single circulating nurse present during WALANT hand surgeries may improve nurse staffing, drive greater turnover efficiency, and reduce costs. (Journal of Surgical Orthopaedic Advances 30(3):156–160, 2021)

Key words: Association of PeriOperative Registered Nurses (AORN), field sterility, hand, local anesthesia systemic toxicity, surgical site infection, wide-awake local anesthesia no tourniquet (WALANT)

Alba Avoricani, BA; Qurratul-Ain Dar, BS; Kenneth H. Levy; and Steven M. Koehler, MD