Wide-awake local anaesthesia no tourniquet hand surgery in Australia: an analysis of adoption, perceptions, and implementation in a global context

BackgroundWide-awake local anaesthesia no tourniquet (WALANT) is increasingly used globally for hand surgery, offering clinical and operational benefits. However, its adoption in Australia remains understudied. This study assessed current WALANT usage among Australian hand surgeons to identify key factors influencing its implementation. MethodsA national cross-sectional survey of all Australian Hand Surgery Society (AHSS) active members (n 164) was conducted in 2024. The survey examined current WALANT use, perceived benefits and drawbacks, as well as facilitators and barriers of incorporation into practice. Quantitative data were analysed using descriptive and inferential statistics and qualitative data were analysed thematically. ResultsSixty-eight surgeons responded (41% response rate). Seventy percent had performed WALANT at least once, and 50% incorporated it in practice. Current WALANT use was associated with hand surgery fellowship (OR 8.7), prior WALANT exposure during training (OR 6.1), and practice in university/teaching hospital (OR 3.2). Respondents highlighted avoidance of general anaesthesia, shorter recovery, improved patient satisfaction, and lower costs as benefits. Conversely, workflow inefficiencies, limited outpatient infrastructure, concerns over anaesthetist scheduling and remuneration, and the absence of dedicated billing codes were the dominant barriers. Non-users viewed WALANT as more complex and remained wary of adrenaline safety, whereas users perceived more benefits and reported few technical concerns. ConclusionWALANT is used by a substantial proportion of Australian hand surgeons, but broader adoption is limited by systemic and institutional barriers contributing to perception gap. Training, infrastructure, policy reform, appropriate funding mechanisms, and interprofessional collaboration may support wider integration of WALANT in Australia.