{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T17:03:27Z","timestamp":1776877407959,"version":"3.51.2"},"reference-count":105,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hand surgery is increasingly transitioning from hospital operating theatres to outpatient settings, requiring anaesthetic methods that are efficient, cost-effective, and patient-centred. Traditional anaesthesia, such as general anaesthesia, poses challenges including prolonged recovery and physiological stress. Novel strategies, such as Wide-Awake Local Anaesthesia No Tourniquet (WALANT), ultrasound-guided distal nerve blocks, and adjunctive approaches (vapocoolant spray, patient-controlled regional analgesia, cryoanalgesia, jet injectors), have emerged to address these limitations. This narrative review consolidates current evidence regarding the efficacy, applicability, and economic implications of these evolving anaesthesia techniques. Methods: A literature search was conducted across MEDLINE, Embase, CENTRAL, and Scopus databases up to 1 June 2025. Inclusion criteria were English-language original studies on WALANT, vapocoolant sprays, ultrasound-guided distal nerve blocks, or emerging adjunctive anaesthesia methods applicable to hand and upper limb surgery. Exclusion criteria included non-English publications and those without original clinical data. Two independent reviewers screened and selected studies, ensuring relevance and methodological quality. Results: WALANT can provide high patient satisfaction, cost savings of 70\u201385%, and allow for real-time functional testing during surgery. Ultrasound-guided nerve blocks provided targeted analgesia, preserved elbow function, reduced the need for sedation, and improved perioperative efficiency. Adjuncts such as vapocoolant sprays significantly decreased needle-injection discomfort, offering quick and economical analgesia for superficial procedures. Other emerging adjuncts, including patient-controlled regional anaesthesia (PCRA), cryoanalgesia, and jet injectors, offered additional patient-tailored pain management options, although with higher resource demands. Conclusions: The review highlights the transformative potential of WALANT and adjunctive techniques to enhance efficiency, patient experience, and cost-effectiveness in hand surgery. Despite clear benefits, optimal application requires tailored patient selection, clinician familiarity, and consideration of procedure-specific demands.<\/jats:p>","DOI":"10.3390\/jcm14176146","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:01:13Z","timestamp":1756818073000},"page":"6146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Hand Surgery Anaesthesia Innovations: Balancing Efficiency, Cost, and Comfort with WALANT, Ultrasound, and Emerging Adjuncts\u2014A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3471-8656","authenticated-orcid":false,"given":"Omar","family":"Shadid","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Surgery, The University of Melbourne, Melbourne 3051, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3919-904X","authenticated-orcid":false,"given":"Jennifer","family":"Novo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, University of Notre Dame, Sydney 2010, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2480-7825","authenticated-orcid":false,"given":"Raj","family":"Saini","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A1S6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8621-8216","authenticated-orcid":false,"given":"Gianluca","family":"Marcaccini","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7873-4085","authenticated-orcid":false,"given":"Brett K.","family":"Sacks","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne 3199, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4092-182X","authenticated-orcid":false,"given":"Warren M.","family":"Rozen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne 3199, Australia"},{"name":"Faculty of Medicine and Surgery, Peninsula Clinical School, Monash University, Melbourne 3199, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5444-8925","authenticated-orcid":false,"given":"Ishith","family":"Seth","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne 3199, Australia"},{"name":"Faculty of Medicine and Surgery, Peninsula Clinical School, Monash University, Melbourne 3199, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8396-095X","authenticated-orcid":false,"given":"Roberto","family":"Cuomo","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ocl.2017.08.009","article-title":"Hand Surgery in the Ambulatory Surgery Center","volume":"49","author":"Thompson","year":"2018","journal-title":"Orthop. 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