A Luke MacNeill1, D Joshua Mayich2. 1. University of New Brunswick, Saint John, NB, Canada. Electronic address: luke.macneill@unb.ca. 2. Horizon Health Network, Saint John, NB, Canada.
Abstract
BACKGROUND: The "wide-awake" approach to foot and ankle surgery is characterized by a surgeon-administered mixture of local anesthetic and epinephrine. No tourniquet, sedation, or general anesthesia are required for surgery. This paper describes a retrospective survey of the initial patients to undergo wide-awake foot and ankle surgery at our center. METHODS: Thirty former wide-awake patients were surveyed about their perioperative anxiety, pain, and satisfaction. RESULTS: Twenty-seven of 30 patients (90%) completed the survey. Patients received a variety of forefoot, hindfoot, and lower leg procedures. In general, they reported a decrease in anxiety over the course of the perioperative period (p=0.005). Pain fell from the preoperative to the intraoperative period, then rose to preoperative levels during recovery (p<0.001). Most patients said that the surgery was better than expected (83%); would choose wide-awake surgery for a subsequent procedure (87%); and would recommend wide-awake surgery to someone who required surgery (88%). CONCLUSIONS: Results indicate that the wide-awake approach to foot and ankle surgery causes little discomfort to patients who receive many common procedures. The removal of hindfoot hardware under local anesthesia is contraindicated.
BACKGROUND: The "wide-awake" approach to foot and ankle surgery is characterized by a surgeon-administered mixture of local anesthetic and epinephrine. No tourniquet, sedation, or general anesthesia are required for surgery. This paper describes a retrospective survey of the initial patients to undergo wide-awake foot and ankle surgery at our center. METHODS: Thirty former wide-awake patients were surveyed about their perioperative anxiety, pain, and satisfaction. RESULTS: Twenty-seven of 30 patients (90%) completed the survey. Patients received a variety of forefoot, hindfoot, and lower leg procedures. In general, they reported a decrease in anxiety over the course of the perioperative period (p=0.005). Pain fell from the preoperative to the intraoperative period, then rose to preoperative levels during recovery (p<0.001). Most patients said that the surgery was better than expected (83%); would choose wide-awake surgery for a subsequent procedure (87%); and would recommend wide-awake surgery to someone who required surgery (88%). CONCLUSIONS: Results indicate that the wide-awake approach to foot and ankle surgery causes little discomfort to patients who receive many common procedures. The removal of hindfoot hardware under local anesthesia is contraindicated.
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Authors: Christopher A Colasanti; Daniel J Kaplan; Jeffrey S Chen; Ajay Kanakamedala; John F Dankert; Eoghan T Hurley; Nathaniel P Mercer; James W Stone; John G Kennedy Journal: Arthrosc Tech Date: 2022-02-25