A prospective comparison of wide-awake local anesthesia and general anesthesia for forefoot surgery

Abstract

Background: A recent case series suggested that surgery with wide-awake local anesthesia is tolerated well by most foot and ankle patients. However, patients were assessed retrospectively and there was no comparison group to show the relative efficacy of this approach. The present study was conducted to address these concerns.

Methods: Perioperative pain and anxiety were assessed in 40 patients receiving forefoot surgery using either wide-awake local anesthesia or general anesthesia. Ratings were collected on the day of surgery using 11-point (0-10) numerical rating scales.

Results: Patients in the two anesthesia groups reported no differences in preoperative pain (p=0.500) or anxiety (p=0.820). Patients who received wide-awake local anesthesia reported lower levels of postoperative pain (p<0.001) and anxiety (p<0.001) than patients who received general anesthesia. They also reported little pain (M=0.17, SD=0.32) or anxiety (M=1.33, SD=1.74) during the operation.

Conclusions: Results indicate that surgery with wide-awake local anesthesia is tolerated well by most patients, and that it may have some benefit compared to surgery with general anesthesia.

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