For many years now, Donald Lalonde has been an advocate for the use of performing hand surgery in the awake patient without the use of a painful tourniquet. Also known as wide awake local anaesthesia no tourniquet (WALANT) this book is the culmination of years of experience of the technique and acts as a handbook to its practice and applications in clinical management.

The book is divided into four parts and each chapter is supported by a video clip to reinforce the messages in the book.

The book begins with an atlas of the distal forearm and hand nerves that can be blocked using buffered lidocaine with adrenaline. The diagrams are simple and give suggested doses of the local anaesthetic and where to inject them. The area that can be expected to be anaesthetised with associated vasoconstriction is demonstrated, but also shows where the surgeon can expect anaesthesia without vasoconstriction, suggesting that more local anaesthetic can be injected where needed.

Subsequent parts of the book introduce the general principles of wide awake hand surgery, specific details of how to perform common hand procedures using WALANT, and finally goes on to describe how the technique can be applied to more complex reconstructions of the hand. The chapters have been written in association with a number of world experts in hand surgery who are proponents of WALANT and are able to offer their perspective of its use in the real world.

The value of this book lies not just in its clear description of the specifics of the use of WALANT, but also in the discussion about the logistics of its use. It provides a clear argument as to the benefits to the patient and the advantages to the surgeon, and also gives the reader tips on how to run a list using the technique.

Overall, I would suggest that this text is essential to those of you who wish to undertake this technique in clinical practice, and its application may improve efficiency of operating lists and result in optimised patient outcome and satisfaction.

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Claire Simpson

St John’s Hospital at Howden, Livingston, UK.

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