WAFER Trial: A randomized controlled trial comparing Wide-awake Local Anesthesia No Tourniquet (WALANT) to…

Randomized trialPlastic and reconstructive surgery· Jul 2026

WAFER Trial: A randomized controlled trial comparing Wide-awake Local Anesthesia No Tourniquet (WALANT) to General and Regional Anesthesia with tourniquet for Flexor Tendon Repair.

Ryan Faderani, Muholan Kanapathy, Juliette Bray … Dariush Nikkhah

Hand & WristRandomized trialClinical practiceQ1IF 2.8

Wide-awake local anesthesia without tourniquet cut intra-operative costs by 54% versus general/regional anesthesia.

WAFER Trial: A randomized controlled trial comparing Wide-awake Local Anesthesia No Tourniquet (WALANT) to General and Regional Anesthesia with tourniquet for Flexor Tendon Repair.

Ryan Faderani … Dariush Nikkhah

Plastic and reconstructive surgery · Jul 2026

Background

Wide-awake local anesthesia no tourniquet (wide-awake local anesthesia no tourniquet) is increasingly used for flexor tendon repair, but comparative data versus general/regional anesthesia(GA/RA) are limited.

Purpose

The aims of the WAFER trial were to generate high quality comparative data on wide-awake local anesthesia no tourniquet versus GA/RA for flexor tendon repair and assess the feasibility of performing a large multicenter trial of this nature.

Methods

Were randomized on a 1:1 basis to have flexor tendon repair under GA/RA or wide-awake local anesthesia no tourniquet.

Results

wide-awake anesthesia cut operating-room costs versus general or regional anesthesia

MD -398 (95% CI -509 to -287)

CI excludes the null - significant

More results

At 6 months, mean TAM score(SE) for GA/RA was 67.6(5.6) vs 60.3(6.3) in the wide-awake local anesthesia no tourniquet group.

Tendon rupture was reported in two patients in the GA/RA group and three in the wide-awake local anesthesia no tourniquet group.

More results

PROMs improved over time in both groups, patients in the wide-awake local anesthesia no tourniquet arm reported consistently higher MHQ scores across domains.

Participants in wide-awake local anesthesia no tourniquet arm returned to work earlier than participants in GA/RA arm (mean 3.0 vs 6.7weeks).

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Conclusion · 1 of 2

A pragmatic comparison of wide-awake local anesthesia no tourniquet versus GA/RA with tourniquet for primary flexor tendon repair is deliverable and safe.

Conclusion · 2 of 2

Inter-arm clinical differences were small; however, wide-awake local anesthesia no tourniquet showed lower intra-operative costs and a signal for earlier return to work.

WAFER Trial: A randomized controlled trial comparing Wide-awake Local Anesthesia No Tourniquet (WALANT) to General and Regional Anesthesia with tourniquet for Flexor Tendon Repair.

WAFER Trial: A randomized controlled trial comparing Wide-awake Local Anesthesia No Tourniquet (WALANT) to General and Regional Anesthesia with tourniquet for Flexor Tendon Repair.

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