Wide-awake hand surgery, also known as WALANT (Wide-Awake, Local Anesthesia, No Tourniquet), is a type of hand surgery in which anesthesia is accomplished with lidocaine with epinephrine, with the patient fully awake and not sedated. The WALANT protocol has been popularized by Lalonde, who showed that lidocaine with epinephrine can successfully and safely be used to create an adequately bloodless surgical field and thereby eliminate the need for a tourniquet. His landmark prospective study debunked the long-held myth that local anesthesia containing epinephrine should not be injected into the hand. The WALANT technique for hand surgery makes it feasible to perform a variety of common procedures in an office setting without the need for an operating room, with many advantages including greater cost effectiveness, lack of a need for sedation, fewer delays in scheduling surgery, greater procedural efficiency, and greater patient satisfaction. This surgical technique guide reviews the principles and techniques of wide-awake hand surgery, and provides specific case examples of wide-awake hand surgery in clinical practice.Quick Tips