Abstract
INTRODUCTION: The wide-awake-local-anaesthesia-no-tourniquet (WALANT) technique is increasingly used in hand surgery, avoiding general or regional anaesthesia and upper arm tourniquets. Clinical and economic benefits have been shown especially for trigger finger and carpal tunnel release; however, its impact on fracture treatment warrants evaluation. METHODS: We conducted a single-centre retrospective analysis of 921 metacarpal and phalangeal hand operations for fracture treatment, including both fixation and removal of metalwork. The operation time and cost of procedures performed under WALANT were compared with those using regional anaesthesia (RA) with brachial plexus block. Reimbursement for the procedures were compared with the cost. RESULTS: The WALANT technique significantly reduced the operation time and treatment cost compared with RA. However, we found that the reimbursement structure did not fully cover the procedural expenses in either group. Despite this, WALANT reduced financial deficits, demonstrating superior cost-effectiveness. CONCLUSION: In addition to reducing operative time and overall procedural costs, WALANT decreased dependence on anaesthesia capacity, thereby improving the efficiency of surgical workflows. This approach also promotes a more sustainable model of healthcare delivery by minimizing resource consumption and simplifying logistics. Moreover, its cost-effectiveness may enhance the long-term economic feasibility of reimbursement and funding systems within modern healthcare structures. LEVEL OF EVIDENCE: IV.