Wide-awake foot and ankle surgery: A retrospective analysis

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.

Keywords: Anxiety; Epinephrine; Local anesthesia; Pain; Wide-awake.