Wide-Awake Local Anesthetic No Tourniquet Surgery of the Foot and Ankle.

Wide awake local anesthetic no tourniquet (WALANT) surgery of the foot and ankle has the potential to offer safe and effective surgeon-based anesthesia for a significant number of surgeries about the foot and ankle. This has been documented with significant and growing body of literature. WALANT could offer significant advantages with respect to patient experience, per case cost of procedures as well as for improving access for patients to operative resources in a setting of scarcity or restricted access.

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

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.