A systematic review of the Wide Awake Local Anesthesia no Tourniquet (WALANT) approach in pediatric hand surgery.

Background and purpose: Wide Awake Local Anesthesia No Tourniquet (WALANT) for hand surgery in children and adolescents remains limited due to concerns regarding patient cooperation. This systematic review aims to synthesize the existing evidence on WALANT in the pediatric population to guide future directives. Methods: This systematic review was performed in accordance with PRISMA guidelines. In June 2025, a comprehensive search of MEDLINE, Embase, Web of Science, and CENTRAL was conducted. All studies reporting on WALANT in patients <18 years old were retrieved without date restrictions. For those meeting inclusion criteria, study and patient characteristics, interventions, and outcomes were extracted and analyzed. In addition, study quality was assessed based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Results: Eleven studies were identified, including 441 patients and 507 procedures. No major complications were documented, and conversion to sedation or general anesthesia was required in only 0.6% of patients. Overall, the procedures were successful, as shown by consistent improvements in hand function. Patient feedback suggested high levels of satisfaction and minimal perioperative pain. Additionally, certain studies observed marked reductions in operative time, room time, recovery time, hospital stay, and costs. Conclusions: Although the literature is limited, our findings demonstrate that WALANT is a safe, feasible and effective alternative to systemic anesthesia in children and adolescents. Key considerations include appropriate patient selection, child-centered communication strategies, distraction techniques, and supportive environments. This supports the broader integration of WALANT into pediatric practice. However, further research is warranted to optimize patient experience and assess institutional benefits.