Comment j’optimise l’expérience patient au Centre universitaire de Saint John (Canada).

Three simple improvements are profoundly transforming surgical practice across numerous specialties in Canada and around the world. 1. In 2024, any surgeon can easily learn to perform high-volume "tumescent" local anesthesia with diluted lidocaine and epinephrine over large areas of the body, with virtually no injection pain, eliminating the need for sedation. 2. It is now well-established that epinephrine is safe for use in fingers and toes. Consequently, a tourniquet is no longer required for most limb surgeries, meaning patients no longer need sedation to tolerate a tourniquet. 3.There is now abundant evidence that infection rates do not increase when procedures are performed outside the operating room in minor procedure rooms with minimal draping. Eliminating sedation and the need for an anesthesiology team further facilitates the shift of surgeries to minor procedure rooms (whether in hospitals or clinics).

WALANT is an acronym summarizing these three changes: Wide Awake Local Anesthesia No Tourniquet. A PubMed search for the term "WALANT" on January 10, 2025, yielded 354 global publications since 2013.

WALANT applies to most surgeries of the hand, foot, ankle, tendons, and nerves, as well as excision/reconstruction of skin cancers, cosmetic surgery, abdominal hernia repair, upper and lower limb amputations, and fixation of fractures in the forearm, elbow, and clavicle, among others.

WALANT significantly reduces costs (savings on personnel and equipment) and waste (greatly reduced carbon footprint in clinics versus operating rooms). Lastly, WALANT enhances patient safety and comfort by eliminating complications caused by sedation, such as nausea and vomiting, venous and pulmonary thromboembolism, urinary retention, malignant hyperthermia, and aspiration pneumonia.