Clinical Outcomes and Patient Satisfaction Following WALANT Hand and Wrist Surgery in a Regional Island Hospital: A Retrospective Observational Study From the Maldives

BackgroundWide Awake Local Anaesthesia No Tourniquet (WALANT) is increasingly used for hand and wrist surgery because it permits procedures to be performed without sedation, general anaesthesia, or pneumatic tourniquet application.These characteristics may be particularly advantageous in regional healthcare systems with limited anaesthesia and operating theatre resources.However, evidence regarding WALANT outcomes in regional island healthcare settings such as the Maldives remains limited. ObjectiveTo evaluate clinical outcomes, postoperative functional status, patient satisfaction, recovery characteristics, and complications following hand and wrist procedures performed using the WALANT technique at a regional hospital in the Maldives. MethodsWe retrospectively analysed routinely collected operative records, completed questionnaires, and follow-up data of 62 adults who underwent WALANT hand or wrist surgery at Kulhudhuffushi Regional Hospital between June 2024 and May 2025.A commercially premixed solution of 2% lignocaine with adrenaline 1:80,000 was used without sodium bicarbonate.Outcomes included perioperative visual analogue scale pain scores, postoperative QuickDASH scores, patient experience, recovery, and complications.Complete data for the reported outcomes were available for all 62 included patients. ResultsThe mean age was 44.5 ± 12.8 years, and 38 patients (61.3%) were female.Carpal tunnel syndrome was the most common diagnosis (24/62, 38.7%).Mean VAS pain scores were 3.10 ± 1.30 during local anaesthetic injection and 1.40 ± 0.79 intraoperatively.Fifty-five patients (88.7%) described the intraoperative experience as comfortable or very comfortable.Same-day discharge was achieved in 56 patients (90.3%),50 (80.6%)returned to daily activities within one week, and 54 (87.1%) returned to work within four weeks.The mean postoperative QuickDASH score was 28.50 ± 12.93.Fifty-four patients (87.1%) were satisfied or very satisfied with their WALANT experience, and 57 (91.9%) indicated that they would undergo WALANT again if required.Five patients (8.1%) had recorded postoperative complications, comprising two wound infections (3.2%), two cases of transient numbness (3.2%), and one haematoma (1.6%).One patient undergoing a trauma-related fracture procedure required reoperation because of poor fracture alignment.No major anaesthetic complication or digital ischaemia was recorded.No conversion to general anaesthesia was required. ConclusionsIn this single-centre series, WALANT was feasible for selected hand and wrist procedures in a regional island hospital and was associated with low perioperative pain, high patient satisfaction, and frequent same-day discharge.Postoperative complications were recorded in five patients (8.1%), with no major anaesthetic complications or digital ischaemia observed.These findings support further evaluation of WALANT as an ambulatory surgical approach in comparable regional and resource-constrained healthcare settings.Prospective multicentre comparative studies incorporating baseline and longitudinal functional assessment are warranted.