Background: A large number of hand surgeons are now using wide-awake local anesthesia with no tourniquet (WALANT) instead of traditional surgery using a tourniquet and sedation. Lidocaine and epinephrine plus sodium bicarbonate are the drugs injected for both anesthesia and hemostasis.

Methods: This prospective study was performed in Minia University Hospital, Plastic and Reconstructive Surgery Department on 30 Patients undergoing hand primary flexor tendon repair surgery based on inclusion and exclusion criteria.

Results: Thirty patient were involved in our study. Satisfactory results were achieved in 83.8% of the cases. The duration of surgeries was 45-180 minutes. During this duration there was no pain or blood loss. For the blood loss, the mean ± SD was 64.2±15.5. No necrosis occurred due to epinephrine use in any case. There was a significant difference in VAS score value & VAS grades during WALANT injection, at 3hrs postoperative and 6hrs postoperative compared with during operation and 1hr postoperative with a P value <0.001.

Conclusion: The use of the wide awake technique (WALANT) with avoidance of tourniquet provides an optimal hemostatic field with low blood loss, suitable for long operations with lower pain (VAS score) in the involved cases.

Keywords: wide awake technique (WALANT), Flexor tendon repair, VAS score.