The Orthobullets Podcast Podiums | Hand | Bold Statements: Hand Surgery Should Never Be Done in the OR
Aug 28, 2025
Dr. Kate Nellans, an orthopedic surgeon known for her advocacy of office-based hand surgeries, discusses the revolutionary WALANT technique. She delves into the controversial shift from operating rooms to office settings, highlighting its acceleration during the COVID-19 pandemic. Nellans emphasizes patient safety and procedural effectiveness, questioning the traditional norms of anesthesia usage. With insights on evaluating financial factors and practical logistics, she shares the benefits and challenges of this emergent surgical practice.
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WALANT Origins And Growth
- WALANT (Wide Awake Local Anesthesia No Tourniquet) shifts many common hand procedures out of the OR into office settings.
- It arose from resource limits and gained traction during COVID and outpatient trends.
How WALANT Began
- Don Lalonde developed WALANT in Canada because OR access was limited and anesthesia scarce.
- The technique later expanded to low-resource countries and accelerated in the U.S. during COVID.
Epinephrine Myth Debunked
- Historical fear of epinephrine in digits came from older mixtures that caused necrosis, not modern lidocaine-epinephrine.
- Modern series (Lalonde) report extremely low digit-loss rates with proper technique.